Gestational diabetes mellitus：妊娠期糖尿病.ppt

Risk factors for preeclampsia include any vascular complications and preexisting proteinuria, with or without chronic hypertension Risk of preeclampsia 11-12% in Class B, 21-22% in class C, 21-23% in class D, 36-54% in class F-R Only 1% Most serious complication May develop with hyperemesis gravidarum, B-mimetic drugs given for tocolysis, infection and corticosteroids Fetal loss is about 20% Pregnant women usually have ketoacidosis with lower blood glucose levels than when nonpregnant (293 mg/dl VS 495 mg/dl) ABG, serum ketone, electrolyte, blood glucose q 1-2 hr Insulin IV infusion : loading 0.2-0.4 u/kg, maintenance 2-10 U/h Fluids : NSS 1 L in first hour, 500-1000ml/h for 2-4 h, 250 ml/h until 80% replaced Begin 5%D/NSS when glucose plasma level reaches 250 mg/dl Correct electrolyte : K, bicarbonate All types of infections : candida vulvovaginitis, urinary infection, respiratory tract infection, puerperal pelvic infection, wound infection Renal infection was associated with increased preterm delivery Optimal preconceptional glucose control using insulin Preprandial 70-100 mg/dl, 1hr postprandial 140 mg/dl, 2 hr 120 mg/dl Hb A1c within or near the upper limit of normal (6%) Most significant risk for malformation with levels 10% Periconceptional folic acid 400 ug/d OHD are not recommended for overt diabetes Glycemic control usually achieve with multiple daily insulin injections and adjustment of dietary intake Self-monitoring of capillary glucose levels using a glucometer is recommended A caloric intake of 30-35 kcal/kg/d (for normal weight women) Three meals and three snacks daily Underweight women : 40 kcal/kg/d For those 120% above ideal weight : 24 kcal/d 55% carbohydrate : 20% protein : 25% fat Accurate dating Second trimester : targeted sonographic 18-20 weeks to detect NTD and other anomalies Third trimester : follow growth fetal surveillance Caution : detection of fetal anomalies in obese women is more difficult Avoid hypoglycemia and hyperglycem