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Managing Diabetes in Pregnancy: Complications and Management

Learn about the incidence, classification, maternal, fetal, and neonatal complications of diabetes in pregnancy. Understand diagnostic methods, management strategies, antenatal, intrapartum, and postpartum care. Get insights from Dr. Hythem Al-Sum, a consultant in Obstetrics, ICU, and MFM at KAMC-RD.

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Managing Diabetes in Pregnancy: Complications and Management

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  1. Dr. Hythem Al-Sum Consultant Obstetrics, ICU, MFM MNGHA KAMC-RD Diabetes in Pregnancy

  2. Incidence and Classification • Prevalence increased in the last 20 years • GDM is 3 to 8 % • Pregestational DM is 1 % • GDM is 90% and Pregestational DM is 10%

  3. Progressive insulin resistance state • HPL, progesterone, prolactin, cortisol, TNF • White’s classification

  4. Maternal complicatios • Obstetric: (Polyhydramnios, Preeclampsia, Infections, Cesarean delivery, Genital trauma) • Diabetic emergencies: (Hypoglycemia, DKA • End-organ injury: (cardiac, renal, ophthalmic, peripheral vascular) • Neurologic: (peripheral neuropathy, gastrointestinal disturbance)

  5. Fetal and Neonatal Complications • Macrosomia • Delayed organ maturity • Congenital defects (cardiovascular, NTD..) • Fetal compromise (IUGR, IUFD..)

  6. Diagnosis • Screening between 24 and 28 weeks of gestation • GCT • In the first antenatal visit in high risk population • GTT

  7. Management • Diabetic team • Euglycemia: • FBS < 95 mg/dL • 1 hour PP < 140 mg/dL • 2 hours PP < 120 mg/dL • Diet: • 80 to 120% of IBW: 30 kcal/kg • < 80% of IBW: 35 to 40 kcal/kg • 120 to 150% of IBW: 24 kcal/kg

  8. Therapy • Oral hypoglycemics • Insulin is the gold standard • Dose calculation • Exercise

  9. Antepartum Mx • In pregestational or GDM before 20 weeks: • 1st trimester dating US • Obstetric detailed anatomy scan • Fetal echocardiogram • MSAFP at 16 to 20 weeks • Maternal renal, cardiac, and ophthalmic functions must be evaluated and monitored • HbA1c • Regular fetal monitoring for macrosomia and IUGR • Serial fetal testing in GDM on diet and in GDM on insulin • C.S. for large fetuses (> 4.25 to 4.5 kg)

  10. IntrapartumMx • Maternal euglycemia during labor • Continuous regular insulin infusion • Maintain BG between 80 and 120 mg/dL • Continuous fetal heart rate monitoring

  11. Postpartum Mx • Insulin requirements • Restart on 2/3 the pre-pregnancy dose • GDM usually does not need insulin pp • Check FBS at 6 to 12 weeks • Diet • Sterilization

  12. Thank you!

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