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Diabetes in pregnancy Dr Than Than Yin. Physiological changes Pregnancy is a state of physiological insulin resistance and relative glucose intolerance.

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Presentation on theme: "Diabetes in pregnancy Dr Than Than Yin. Physiological changes Pregnancy is a state of physiological insulin resistance and relative glucose intolerance."— Presentation transcript:

1 Diabetes in pregnancy Dr Than Than Yin

2 Physiological changes Pregnancy is a state of physiological insulin resistance and relative glucose intolerance Glucose handling is altered Glucose tolerance decreases progressively with increasing with pregnancy Renal tubular threshold for glucose fall in pregnancy

3 Diabetes in pregnancy Pre-existing diabetes Gestational diabetes Type 1 0.5% Type2 3-4% Pre-existing GDMTrue GDM -0.4%

4 Complications of pregnancy in pre- existing diabetes Maternal Increased insulin requirements Hypoglycemia Infection Ketoacidosis Deterioration in retinopathy Increased proteinuria and oedema Miscarriage Polyhydramnios Shoulder dystocia Pre-eclampsia (threefold to fourfold increased) Increased caesarean section rate Fetal Congenital abnormalities -4%- neural tube defects, congenital heart disease Increased neonatal morbidity Increased perinatal mortality- 3% Macrosomia Preterm delivery Neonatal hyperglycemia Polycythemia Jaundice Respiratory distress syndrome

5 Diagnosis of diabetes mellitus Random blood glucose >11.1 mmol/Lit Fasting blood glucose >7 mmol/Lit 2 hour plasma glucose concentration >11.1 mmol/Lit after 75mg anhydrous glucose in an oral glucose tolerance test

6 Management Women with diabetes planning pregnancy require pre-pregnancy counseling Pregnant women with diabetes- seen in joint clinic with obstetricians and physicians Multidisciplinary clinics with dieticians and nurse prationers

7 Impaired GTT After fasting -<7.0 After 2hrs - >7.8

8 Medical Management To achieve normoglycemia Increase the frequency of home blood glucose monitoring Target fasting -3.5-5.4 mmol/Lit 7.8 mmol/Lit after postprandial

9 Management Women with type I diabetes require higher doses of insulin Type 2 diabetes Oral hypogylcemic agents- traditionally discontinued in pregnancy NICE guideline states that Metformin can be used


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