1. Diabetes and Pregnancy
Dr. Miems Kleynhans

2. Diabetes and Pregnancy
Can a “normal” person also become diabetic in pregnancy?

3. Gestational Diabetes
Definition: Diabetes with onset or first recognition in pregnancy
Pregestational diabetes: Diabetes diagnosed before pregnancy, type I or II
Gestational diabetes : 87% of all diabetes in pregnancy

4. Who will get gestational diabetes?
It could happen to anybody

5. Should we screen and when?
YES!!!
Ideal world - between weeks gestation
Glucose tolerance test – 75mg
In South Africa?

6. Selective screening : 10 factors
History of previous gestational diabetes
Certain ethnic groups
Older than 35 years
Weight more than 85 kg
First degree family history of DM
History of typical diabetic symptoms
Previous infant over 4kg
Previous stillbirth
Severe polihydramnios
Repeated glycosuria

7. Why should we screen ?

8. What are the effects of diabetes on the pregnancy?
Antepartum:
Congenital abnormalities
Macrosomia
Intrauterine death
Polyhydramnios – preterm labour

9. What are the effects of diabetes on the pregnancy?
Delivery:
Shoulder dystocia
Erb’s palsy

10. What are the effects of diabetes on the pregnancy?
Postpartum:
Neonatal hypoglycaemia
Polycythaemia
Hyperbilirubinaemia
Respiratory distress syndrome

11. Biggest fear? Unexplained intrauterine death
Fetal hyperglycaemia and hyperinsulinemia
Increased fetal oxygen consumption
Fetal hypoglycaemia and acidosis

12. Management Confirm diagnosis Ophthalmologist
Kidney function – 24 hour protein clearance
Blood pressure
Urine – MCS
First trimester screening and detailed anatomy sonar
TSH
HbA1C
Fetal monitoring

13. Treatment Control known diabetic patients optimally before conception
Diet
Insulin – gold standard
Oral hypoglycaemic agents – more studies needed

14. Delivery : When? Often preterm Corticosteroids in hospital
Glucose abnormal up to 5 days
Multidisciplinary decision
Mom vs. fetus

15. Delivery : How? The big debate
Caesarean section vs. normal vaginal delivery
All factors into consideration – macrosomal, timing, urgency, maternal choice . . .

16. Conclusion We have to screen Increasing problem world wide
We can improve outcome dramatically

17. Thank you