Book of Medical Disorders in Pregnancy - Tintash
Book of Medical Disorders in Pregnancy - Tintash
Book of Medical Disorders in Pregnancy - Tintash
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
Oversized<br />
Fetus<br />
Chapter No: 2<br />
DIABETES MELLITUS IN PREGNANCY<br />
Diabetes is a state <strong>of</strong> carbohydrate<br />
metabolism derangement and is<br />
considered to be present when there is<br />
lack <strong>of</strong> effective <strong>in</strong>sul<strong>in</strong> to ma<strong>in</strong>ta<strong>in</strong> a<br />
normal blood sugar on present<strong>in</strong>g<br />
adequate carbohydrate load to the body.<br />
Historic perspective - Prior to the<br />
<strong>in</strong>troduction <strong>of</strong> <strong>in</strong>sul<strong>in</strong> <strong>in</strong> 1921, most<br />
diabetic women were sterile. When<br />
conception took place, the pregnancy<br />
frequently ended <strong>in</strong> spontaneous<br />
abortion, or it precipitated diabetic<br />
acidosis and coma. The relatively few<br />
diabetics who carried pregnancy to term<br />
fre-quently produced stillbirths,<br />
abnormal <strong>in</strong>fants, or <strong>in</strong>fants who died<br />
from undeterm<strong>in</strong>ed causes dur<strong>in</strong>g the<br />
neonatal period.<br />
If diabetes is uncontrolled, it affects<br />
reproductive mechanisms so adversely<br />
that it makes successful child bear<strong>in</strong>g<br />
virtually impossible. Unless the disease<br />
can be carefully controlled and the<br />
metabolic disturbances cured, effect <strong>of</strong><br />
diabetes on the mother and the <strong>in</strong>fant can<br />
be disastrous.<br />
Placenta<br />
Fig2.1: Shows section <strong>of</strong> uterus with<br />
oversized fetus<br />
18<br />
There is no consensus about the<br />
def<strong>in</strong>ition or management <strong>of</strong> gestational<br />
diabetes. It occurs when those who were<br />
not formerly diabetic develop the disease<br />
<strong>in</strong> pregnancy and suffer many <strong>of</strong> the problems<br />
that are common with established<br />
diabetes <strong>in</strong> pregnancy. A number <strong>of</strong> the<br />
hormones <strong>of</strong> pregnancy raise blood<br />
glucose. There are <strong>of</strong>ten other factors<br />
that predispose to impaired glucose tolerance.<br />
Gestational diabetes mellitus (GDM) -<br />
This is characterized by an abnormality<br />
<strong>of</strong> carbohydrate metabolism identified<br />
dur<strong>in</strong>g gestation and found to be absent<br />
on repeat glucose tolerance test<strong>in</strong>g some<br />
time beyond the sixth postpartum week.<br />
Incidence - It has been reported that bet-<br />
ween 1 to 3 per cent <strong>of</strong> all pregnant<br />
women suffer from gestational diabetes<br />
1:250 pregnancies are complicated by all<br />
types <strong>of</strong> diabetes.<br />
Renal blood flow and glomerular<br />
filtration rate (GFR) rise <strong>in</strong> pregnancy<br />
with the result that the renal threshold<br />
for glycosuria is reduced. Glucose<br />
tolerance tests may be unreliable<br />
especially as gastric empty<strong>in</strong>g is delayed<br />
<strong>in</strong> pregnancy.<br />
Hav<strong>in</strong>g had gestational diabetes <strong>in</strong> a<br />
previous pregnancy does not necessarily<br />
mean that it will recur <strong>in</strong> future<br />
pregnancies. A study from Japan looked<br />
at those with previous GDM and also<br />
those with one previous abnormal<br />
feature <strong>of</strong> an oral glucose tolerance test.<br />
About two thirds <strong>of</strong> those with previous<br />
gestational diabetes and around 40% <strong>of</strong><br />
those with one previous abnormal value<br />
developed the condition.
Change language