Presentation on theme: "Dr. Miems Kleynhans. Can a “normal” person also become diabetic in pregnancy?"— Presentation transcript:
Dr. Miems Kleynhans
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 Gestational diabetes : 87% of all diabetes in pregnancy
Who will get gestational diabetes? It could happen to anybody
Should we screen and when? YES!!! Ideal world - between weeks gestation Glucose tolerance test – 75mg In South Africa?
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
Why should we screen ?
What are the effects of diabetes on the pregnancy? Antepartum: 1. Congenital abnormalities 2. Macrosomia 3. Intrauterine death 4. Polyhydramnios – preterm labour
What are the effects of diabetes on the pregnancy? Delivery: 1. Shoulder dystocia 2. Erb’s palsy
What are the effects of diabetes on the pregnancy? Postpartum: 1. Neonatal hypoglycaemia 2. Polycythaemia 3. Hyperbilirubinaemia 4. Respiratory distress syndrome
Biggest fear? Unexplained intrauterine death Fetal hyperglycaemia and hyperinsulinemia Increased fetal oxygen consumption Fetal hypoglycaemia and acidosis
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
Treatment Control known diabetic patients optimally before conception Diet Insulin – gold standard Oral hypoglycaemic agents – more studies needed
Delivery : When? Often preterm Corticosteroids in hospital Glucose abnormal up to 5 days Multidisciplinary decision Mom vs. fetus
Delivery : How? The big debate Caesarean section vs. normal vaginal delivery All factors into consideration – macrosomal, timing, urgency, maternal choice...
Conclusion We have to screen Increasing problem world wide We can improve outcome dramatically