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Diabetes and Pregnancy

Diabetes and Pregnancy. Dr. Miems Kleynhans. Diabetes and Pregnancy. Can a “normal” person also become diabetic in pregnancy?. Gestational Diabetes. Definition : Diabetes with onset or first recognition in pregnancy Pregestational diabetes: Diabetes diagnosed before pregnancy, type I or II

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Diabetes and Pregnancy

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  1. Diabetes and Pregnancy Dr.MiemsKleynhans

  2. Diabetes and Pregnancy Can a “normal” person also become diabetic in pregnancy?

  3. Gestational Diabetes • Definition: Diabetes with onset or first recognition in pregnancy • Pregestational diabetes: Diabetes diagnosed before pregnancy, type I or II • Gestational diabetes : 87% of all diabetes in pregnancy

  4. Who will get gestational diabetes? • It could happen to anybody

  5. Should we screen and when? • YES!!! • Ideal world - between 24-28 weeks gestation • Glucose tolerance test – 75mg • In South Africa?

  6. Selective screening : 10 factors • History of previous gestational diabetes • Certain ethnic groups • Older than 35 years • Weight more than 85 kg • First degree family history of DM • History of typical diabetic symptoms • Previous infant over 4kg • Previous stillbirth • Severe polihydramnios • Repeated glycosuria

  7. Why should we screen ?

  8. What are the effects of diabetes on the pregnancy? • Antepartum: • Congenital abnormalities • Macrosomia • Intrauterine death • Polyhydramnios – preterm labour

  9. What are the effects of diabetes on the pregnancy? • Delivery: • Shoulder dystocia • Erb’s palsy

  10. What are the effects of diabetes on the pregnancy? • Postpartum: • Neonatal hypoglycaemia • Polycythaemia • Hyperbilirubinaemia • Respiratory distress syndrome

  11. Biggest fear? • Unexplained intrauterine death • Fetal hyperglycaemia and hyperinsulinemia • Increased fetal oxygen consumption • Fetal hypoglycaemia and acidosis

  12. Management • Confirm diagnosis • Ophthalmologist • Kidney function – 24 hour protein clearance • Blood pressure • Urine – MCS • First trimester screening and detailed anatomy sonar • TSH • HbA1C • Fetal monitoring

  13. Treatment • Control known diabetic patients optimally before conception • Diet • Insulin – gold standard • Oral hypoglycaemic agents – more studies needed

  14. Delivery : When? • Often preterm • Corticosteroids in hospital • Glucose abnormal up to 5 days • Multidisciplinary decision • Mom vs. fetus

  15. Delivery : How? • The big debate • Caesarean section vs. normal vaginal delivery • All factors into consideration – macrosomal, timing, urgency, maternal choice . . .

  16. Conclusion • We have to screen • Increasing problem world wide • We can improve outcome dramatically

  17. Thank you

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