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Diabetes in Pregnancy

Dr. Hythem Al-Sum Consultant Obstetrics, ICU, MFM MNGHA KAMC-RD. Diabetes in Pregnancy. 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%. Progressive insulin resistance state

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Diabetes in Pregnancy

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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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