Indian Write- Ups

Management

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Pregnancy & Diabetes

Dr. Anirban Majumder MD., DM(PGT)Department of Endocrinology, I.P.G.M.E. & R., Kolkata

Effect Of Diabetes On Pregnancy

Foetal effect

Macrosomia
Hypoglycaemia
Hypocalcaemia
Polycythemia
Hyperbilirubinaemia
Renal vein thrombosis
Persistent foetal circulation
Cardiomyopathy

Some foetal effects are unique for pregestational diabetes and do not occur in gestational diabetes –

Respiratory distress syndrome
Congenital malformation :
- Neural tube defect
- Congenital Heart Disease
- Congenital renal anomaly.

Maternal Effect

Preeclampsia & Eclampsia
Pyelonephritis
Hydramnios
PPH & 10 fold increased maternal mortality

Diagnosis

For pregestational diabetes (W.H.O. Criteria)

For gestational diabetes, screening is done in all patients (pregnant) between 24-28 weeks, with 50 gm glucose challenge irrespective of the time of the day & meal.

After 1 hr, value of glucose > 140 mg/dl is an indication for 100 mg challenge test. At least two values after 100 gm oral glucose challenge should cross the reference range for diagnosis of GDM:

	Fasting	2hr after 75 gm (OGTT oral glucose)
Normal	< 100 mg/dl	<140 mg/dl
Diabetic	>=140 mg/dl	>=200 mg/dl

Conclusion

Increasing evidence suggests that intrauterine

Fasting: >105 mg/dl

1 Hour: >190 mg/dl

2 Hour: >165 mg/dl

3 Hour: >145 mg/dl

(All values are expressed in venous plasma glucose).

Fasting means a 8-14 hour fasting, change in metabolic environment may have long term implications in the offspring.

Ketonemia during pregnancy is associated with impaired intellectual performance in childhood.
There is high prevalence of obesity in the offspring of the diabetic mother.
Metabolic alteration results in premature maturation of foetal ß cells and hyper-insulinism which predisposes altered glucoregulation and ultimately Type 2 diabetes. High incidence of Type 2 diabetes is found in the offspring of diabetic mother.
Women who develop diabetes during pregnancy, they have an inherent defect in ß cells and most of them (about 50%) develop Type 2 diabetes one or two decades later.

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