2. Diabetes in pregnancy Zohar Nachum, MD Director of Maternal-Fetal Medicine Unit Ob&Gyn Dept Ha’Emek Med Center, Afula

3. Case 25 yr old, 6 yr DM Consultation before pregnancy Type of DM – type 1 Complications – workup Thyroid function tests Folic acid

4. Glucose control

5. Glucose Control Glucose profile, SC sensor, IV sensor Diet Insulin Oral hypoglycemics Multiple injections vs pump Insulin analogs Tight control – prevention of complications vs hypoglycemia 95 – 120 - 95

7. First trimester Complications – abortions, malformations NT Hypoglycemia, diabetic ketoacidosis Class – control, compliance, vasculopathy Second trimester Targeted US – 15 w, 22 w TT Learning disabilities in school

8. Third trimester GDM – GCT - OGTT – 105 – 190 – 165 – 145 - 95 - 180 - 155 – 140 PTD - steroids Growth – LGA, SGA Testing – NST, BPP, Doppler, OCT

10. Delivery 38 w – EFW – clinical, US - > 4000 gr – CS - PV - 3700 – 3999 – induction Glucose control during labor and delivery

12. Post Partum - child Neonatal complications – RDS Hypoglycemia Hyperbilirubinemia Polycytemia Hypocalcemia, hypomagnesemia Long term – Obesity, DM, learning disabilities

13. Post Partum - mother Hypoglycemia DM – post GDM - later in life Next pregnancy - GDM Contraception – combined OC, IUD, progestin only

14. Diabetic named Ruth began to inject “The conventional way – should I reject?” “The answer is clear as a dove The treatment is like making love The intestifued way gets the best effect…” Summary

15. Thank you