CLASSIFICATION

Diabetes mellitus type I --insulin dependent (Ketosisprone)

Diabetes mellitus type II--non-insulin dependent
(Ketosis-resistant)
Impaired Glucose Tolerance
and Gestational Diabetes
(IGT)
SCREENING
Why.
30% have none of the
Above risk factors
Not all DM, IGT, have
persistent glucosuria
50% of pregnant women
have glucosuria at some
time

MATERNAL
Obstetric: Polyhydramnios,
pre-eclampsia (10-15%)
Diabetic Emergencies:
Hypoglycaemia, Ketoacidosis,
Diabetic coma
Vascular & End-Organs:
Renal,
Ophthalmic, Peripheral
vascular
Neurologic: Peripheral

DIABETES IN PREGNANCY
DIABETOGENIC
DEFINITIONS
EFFECTS OF
PREGNANCY
Insulin resistance
DM= Fasting venous glucose
Increased lipolysis
concentration > 8.0 mmol/l
and 2 hrs (75 gm load ) > 11.0 mmol/l
Altered maternal
(or) one of the above + Symptoms
gluconeogenesis
IGT = Fasting < 8.00 mmol/l, but 2
hr (75 gm load) = (9.0-10.9)

PRESENTATION
-Symptoms
-Risk factors (hx &
examination)
-Blood tests-screening

RISK FACTORS

Age > 30
Family history of DM
Past history of: Diabetes in a previous pregnancy, Unexplained IUFD, Neonatal
death, Congenital abnormalities, Recurrent abortions, Large babies > 90 th centile
Obesity
HTN in multipara
Polyhydramnios
Recurrent infections: Urinary, Fungal
Significant Glycosuria

COMPLICATIONS
FETAL
(1) Macrosomia & Traumatic delivery (30% in seemingly controlled)
(2) Delayed organ maturity (RDS) 6 times
(3) Congenital malformations:
Cardiovascular: Transposition of great vessels, VSD, ASD,
Aortic coarctation
Central Nervous system: Anencephaly, Holoprosencephaly,
Encephalocele
Skeletal & spinal - Caudal regression
Genitourinary - Renal agenesis, ureteral dupliction

NEONATAL
Hypoglycaem
ia
RDS
Hypocalcaem
ia
Polycythaemi
a

neuropathy
GI disturbance
Infections: Urinary

Gastrointestinal - anal atresia

** Note: when a two-vessel cord is found, suspect a high incidence of
congenital anomalies
(4) Intrauterine fetal Death
(5) Growth restriction (in
advanced DM)

MANAGEMENT

Start in preconception time

Specific during pregnancy
SPECIFIC

Diet:
16 x Wt. (pounds ) + 300 = CALORIES
Carbohydrates
60%
Fat
20%
Protein
20%
Insulin:
Regiment A
* 3 times sol.-with meals + lnt. Evening
Or
- Regiment B
* 2 types (short & intermediate)
Twice Daily
Dose (daily) = wt. (kg) x 0.6 first
x 0.7 second
x 0.8 third
2/3 in A.M.
2/3 1nt + 1/3 short
1/3 in P.M.
1/2 1nt + short.

CONTROL
Control :
Fasting < 5.0 mmol/1
2 hrs P.P. < 7.0 mmol/1
Adjustment when necessary
Glycosylated Hb A1c (retrospective) < 6
Fetal well being:
AFP 16-18 wks
Detailed scan 19-20 wks
Biophysical assay from 28 wks
Fetal wt. & growth two weekly (3rd)
Delivery:
- Timing depends on: (Around 38 wks)
Maternal factors
Biochemical control
Fetal status
- Method --- LSCS in any medical or obstetric complication.
**Insulin dose adjusted on hourly basis with caloric
requirements intravenously.