Diabetes Mellitus.ppt

Diabetes Mellitus Liu Wei Department of Ob Gy Ren Ji hospital General Consideration Diabetes mellitus complicating pregnancy Diabetes mellitus is diagnosed before this pregnancy Gestational diabetes mellitus (GDM) Carbohydrate intolerance of varying degree of severity with onset or first recognition during pregnancy. Incidence 1%-2% (our country); 1%-10% (other countries) The impact of pregnancy on DM The first half of pregnancy Relative insulin sensitivity: insulin requirement↓ Morning sickness: hypoglycemia The latter half of pregnancy Increased insulin resistance: placental hormones↑ Intake↓intrapartum: hypoglycemia Postpartum: placental hormones↓→hypoglycemia Effects on mother and fetus Effects on monther Spontaneous abortion Preeclampsia Infection: urinary infection Polyhydramnios (羊水过多) Fetal macrosomia(巨大儿), dystocia(难产) Ketoacidosis (酮症酸中毒) Effects on mother and fetus Effects on fetus Fetal macrosomia Fetal growth restriction Premature labor Fetal malformation Effects on infant RDS Hypoglycemia Diagnosis Diabetes mellitus complicating pregnancy Already diagnosed or easy to be diagnosed GDM History Family history of DM, urine glucose repeatedly (+), recurrent abortion or fetal death, candidal vaginitis(假丝酵母菌阴道炎) Diagnosis Lab examination fasting plasma glucose(空腹血糖): ≥5.8mmol/L twice or more glucose screening test 糖筛查 (50g glucose) 1 hr postchallenge ≥7.8mmol/L→ oral glucose tolerance test, OGTT糖耐量 Diagnosis OGTT (75g glucose) Any two or more plasma glucose values exceed the following thresholds→ GDM 1 hr postchallenge: 5.6 mmol/L 2 hr postchallenge: 10.5 mmol/L 3 hr postchallenge: 9.2 mmol/L 4 hr postchallenge: 8.0 mmol/L One value exceed the threshold→ abnormal glucose tolerance Classification White’s classification of DM in pregnancy A1: gestational diabetes not requiring insulin A2: gestational diabetes requiring insulin B: onset at ≥20 years of age or duration of 10 years C: onset at 10 to 19 years of age or duration o