Book of Medical Disorders in Pregnancy - Tintash

largely related to the problems of a large
baby with shoulder dystocia and
obstructed labor although sudden
intrauterine death, placental
insufficiency and neonatal
hypoglycaemia can all occur. The
traditional pride of a new father to a very
large baby is misplaced. A large baby is
an unhealthy baby.
Most women will apparently recover
after the pregnancy but with a 2 in 3
chance of recurrence in a future
pregnancy. However, the chance of
developing overt diabetes, usually type
2, at some stage is much greater than in
those who did not have it. During
pregnancy, the highest fasting glucose
level, followed by the severity of
glucose
Management of diabetic pregnancy:
The successful management of
pregnancy in a diabetic patient depends
on the close cooperation of a team of the
obstetrician, the internist, pediatrician,
and most importantly, the patient. The
main objective in the management of
diabetes complicated by pregnancy is
rapid con-trol of the disease. The
obstetrician has the unique opportunity
of looking after the interest of the fetus
in utero by meticulous control of
maternal disease.
Diagnosis –
The diagnosis of diabetes mellitus may
be difficult to make during pregnancy,
especially by testing urine sugar alone.
Lactosuria of 100 mgm% or more will
produce a positive test for reducing
substances in the urine. It is commonly
found between 6 and 8 weeks before
delivery, but is rare before that time. A
sugar free urine test does not exclude
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diabetes. The most accurate screening
test is a two hour after meal blood
glucose.
When values over 145 mgm per cent are
found, a glucose tolerance test should be
done after three days of adequate
carbohydrate load. When glucose
tolerance test described above is carried,
diabetes is considered present if any two
or more of the following values are
exceeded; fasting blood sugar of 90
mgm per cent) one hour after glucose,
blood value is 190 mgm per cent. The
values obtained from plasma sugar are
interpreted differently. Similarly
different investigators have used
different values. If a laboratory is not
available in a village where the
physician is practising, 5 mL of blood to
which a sodium fluoride tablet has been
added, can be sent to a nearby
government or private laboratory and
reliable results can be obtained even
after 96 hours.
The usual renal threshold for glucose is
160 to 180 mgm per cent. This is
lowered in pregnancy to 120 to 160
mgm per cent. This excessive loss of
solute such as carbohydrates produces
osmotic diuresis. The loss of fluids and
electrolytes may reach considerable
proportions. The vomiting may further
aggravate this and provoke acidosis readily.
Intolerance and earlier gestational
diabetes are the best predictors for
postpartum diabetes. Impaired glucose
tolerance in the first few months after
delivery is associated with a high risk of
diabetes in the near future. Children
whose mothers had GDM are more
likely to be obese but this does not
necessarily imply a genetic or
intrauterine effect. The parents tend to