diabetes

1
DIABETES IN PREGNANCY

• By Dr. M. Chiduo
• Department of OBGY
• HKMU
• 2023

2
CLASSIFICATION

• DIABETES MELLITUS
• Endocrino -metabolic disorder due to
  insufficient production of Insulin, characterized
  by the elevation of blood glucose, associated
  with glucosuria and cetonaemia.

3
Classification.

• 2. GESTATIONAL DIABETES
• Endocrino -metabolic disorder due to
  insufficient production of Insulin during
  pregnancy which disappears after delivery

4
A high risk of gestational diabetes

• Marked obesity.
• Personal history of gestational diabetes
  mellitus.
• Glucosuria.
• A strong family history of diabetes Parents,
  siblings or Identical twin with diabetes.
• Obstetric History.

5
High Risk

• Obstetric History
• Habitual abortions
• Prematurity
• Unexplained fetal or neonatal death
• Previous Big baby (gt4200 g)
• Fetal malformations
• Polihydramnios

6
Other RISKS.

• Excessive weight gain
• Hypertension
• Nephropathy
• Abnormal Glucose Tolerance Test

7
Effects of Pregnancy on Diabetes

• (Diabetogenic Effect)
• Difficult control on Diabetes
• Increasing metabolic lesion
• Manifestation of the disease
• Progression on vascular lesion

8
Effects of Diabetes on Pregnancy

• Fetus Malformations
• - Abortions
• - IUFD(Intrauterine Fetal
  Death)
• - Macrosomia ( Big Baby)
• - Low birth weight
• ( vascular lesions)
• - Prematurity

9
Effects..

• Maternal Urosepsis
• - Nephropathy
• - Hypertension -
  Retinopathy

10
Diagnosis

• Gestational Diabetes-
• Asymptomatic
• Risk factors
• Investigations

11
Diagnosis

• Diabetes Mellitus
• History
• 5 Ps - Polyuria
• - Polydypsia
• - Polyphagia
• - Paresthesia
• - Pruritis

12
Investigations

• Fasting Blood Glucose
• Random Blood Glucose
• Glucose profile (Insulin vs Glucose)
• Urine for glucose (Glucostix)
• Urine for culture and sensitivity

13
Investigations

• Glucose Tolerance Test
• (High Risk patients at booking, 24 28 weeks)
• Renal function tests
• Renal Ultrasound
• Obstetric Ultrasound (serial)
• Amniocentesis

14
GLUCOSE TOLERANCE TEST (GTT)

• A test for glucose tolerance which is done to
  patients at risk of developing Diabetes.
• Measure fasting blood glucose
• Administer 75 g of Glucose in 240 mls of water
  within 5 minutes
• Measure glucose levels after 1 and 2 hours.

15
Management

• Pre-pregnancy
• Good control of Diabetes
• Glycosylated Hb (HbAIc)
• During Pregnancy
• Diet
• Rest 8 -10 hrs /day
• Inj. Insulin ( Type I/ Uncontrolled)
• Metformin tabs 500 mg/day.
• .

16
Labour and Delivery

• Obstetric Delivery at 38 wks in DM
• Delivery at 40 wks in GD
• Insulin Infusion 5 IU in 500 ml Dextrose (Use
  infusion pump) and
• 2 hrly Blood Glucose levels

17
Management

• Baby
• Resuscitation
• Hypertonic solution of Glucose IV (10-20) 40-60
  ml/kg
• Treat Physiological Jaundice.
• Good Physical Examination.

18
Complications

• Fetus Malformations
• - Abortions
• - IUFD
• - Macrosomia ( Big Baby)
• - Low birth weight ( vascular
  lesions)
• - Prematurity

19
Complications.

• Neonate
• - Hypoglycaemia
• - Respiratory Distress Syndrome
• - Neonatal Physiological Jaundice

20
Complications.

• Maternal Urosepsis
• - Nephropathy
• - Hypertension -
  Retinopathy

21

• Good Control of Diabetes in Pregnancy better
  fetal Outcome!
• Thank you!