Diabetes in Pregnancy

Diabetes in Pregnancy

Definition:
DM is a term used for disorder of carbohydrate metabolism resulting with hyperglycemia with or without glucosuria.
a
Incidence  4 –6%
. Depends on age, parity, and social structure e.g. obesity.
. Incidence increases with age and parity.

Classification:
1- Clinical / overt (10%):
- Insulin dependant or juvenile or non-insulin diabetes.
- Pre-pregnancy diabetes and the patient usually already know she’s diabetic.
- Diagnosis in 80% of patients usually before the pregnancy and the rest after pregnancy.
- Usu type I
- Different complications & outcome
2- Gestational diabetes (90%):
- Diagnosis is during pregnancy or after it.
- May or may not disappear after delivery.
- Predisposing Factors:
a. stress
b.  food intake
c. weight
d. family history of type II DM
e. obstetric Hx of:
-macrosomic baby
-still birth of unknown cause
-polyhydraminos
-recurrent abortions
f. hormonal:
 most hormones produced by placenta during pregnancy have insulin-antagonistic effect
 affects immune rxn of mother  immune rxn to insulin
both of above are corrected after pregnancy
- any female above 25 yrs must be screened for GDM