Diabetes and Pregnancy.ppt

Diabetes and Pregnancy Dr Wong Pui Yee, Bonnie MBChB, MRCOG FHKAM(OG), FHKCOG Subspecialist in Fetal Maternal Medicine 2 parts: Preexisting DM and pregnancy Gestational diabetes Preexisting diabetes in pregnancy Type 1 DM ( IDDM) Type 2 DM (NIDDM) Preexisting DM in pregnancy Effect of pregnancy on pre-existing DM Increase requirement for insulin doses Nephropathy , autonomic neuropathy may deteriorate Progress in diabetic retinopathy (2X) Hypoglycemia Diabetic ketoacidosis Preexisting DM In Pregnancy Effect of preexisting DM on pregnancy Maternal 1. increase risk of miscarriage 2. increase risk of preclampsia 3. increase risk of infection eg vaginal candidiasis, UTI, endometrial or wound infection 4. increase LSCS rate Preexisting DM in Pregnancy (2) Fetal 1. increase risk of congenital abnormalities sacral agenesis, congenital heart disease, neural tube defects Hba1c level Risk normal not increased 8% 5% 10% 25 % Preexisting DM in Pregnancy 2. Perinatal mortality (excluding congenital abnormality ) 2 fold increased 3. Increase risk of sudden unexplained intrauterine fetal death. Complications of pregnancy in pre-existing DM Maternal: Increase insulin requirment’ Hypoglycemia Infection Ketoacidosis Deterioration in retinopathy’ Increased proteinuria+edema Miscarriage Polyhydramnio Shoulder dystocia Preeclampsia Increased caesarean rate Fetal: Congenital abnormalities Increased neonatal and perinatal mortality Macrosomia Late stillbirth Neonatal hypoglycemia Polycythemia jaundice  Maternal hyperglycemia | Fetal hyperglycemia | Fetal pancreatic beta-cell hyperplasia | Fetal hyperinsulinaemia | Macrosomia,organomegaly, polycythaemia, hypoglycemia, RDS Management Aim Achieve maternal near normoglycemic level to prevent adverse perinatal outcomes Diet Low-carbohyd