妊娠合并内科疾病(英文)-妇科八年制教学课件演示课件.pptVIP

Impact of pregnancy on diabetes Increased glucose demands---hypoglycemia （低血糖） Insulin resistance and insufficiency Insulin overdose after delivery Maternal and fetal effects Maternal effects Hypertensive disorders （高血压） Infection （感染） Ketoacidosis （酮症酸中毒） Spontaneous abortion （自发流产） Polyhydramnios （羊水过多） Dystocia （难产） and C-S owing to macrosomia （巨大儿） Recurrent GDM （再次妊娠时复发） Maternal and fetal effects Fetal effects Macrosomia （巨大儿） Fetal growth restriction （胎儿宫内生长受限） Spontaneous abortion Preterm delivery （自发流产和早产） Malformation （胎儿畸形） Maternal and fetal effects Neonatal effects Respiratory distress （呼吸窘迫） Hyperinsulinemia? Pulmonary Surfactant ? ?Delayed pulmonary maturation Hypoglycemia （低血糖） Diagnosis----GDM History: family, previous pregnancy, present pregnancy Screening: 50-g oral glucose challenge test （24-28 weeks） Confirmed diagnosis OGTT: 75/100-g oral glucose tolerance test The 50 gr. GCT (Cutoff 140 mg/dl, 7.8mmol/L) Sensitivity: 93.3% Specificity: 38.2% Positive Predictive Value: 78.6 % Negative Predictive Value : 70.0 % Diagnostic criteria for GDM ---- OGTT Method Criteria (mmol/L) FPG 1 hr. 2 hr. 3 hr. WHO (75 g) 5.6 10.3 8.6 6.7 Diagnosed when 2 or more values are abnormal FPG: Fasting plasma glucose Diagnosis—Overt diabetes polydipsia （多饮）, polyuria （多尿）, unexplained weight loss，ketoacidosis Random plasma glucose 200 mg/dL(11.1 mmol/L); fasting glucose126mg/dL (7 mmol/L) Staging A: GDM B: Overt diabetes, late onset (after 20y), 10y C: Early onset (10- 19y), disease course 10-19y D: onset before 10y or disease course =20y, or retinopathy F: diabetic nephropathy R: proliferative retinopathy or vitreous hemorrhage H: coronary heart disease T: kidney transplantation Management Purpose Maintain glucose level within normal range Minimize fetal and maternal complication Lower peripartum fetal and neonatal mortality During pregnancy Diet To provide the necessary nutrients for the mother and fe