Diabetes Mellitus
Liu Wei
Department of Ob & Gy
Ren Ji hospital
General Consideration
? Diabetes mellitus complicating pregnancy
Diabetes mellitus is diagnosed before this
pregnancy
? Gestational diabetes mellitus (GDM)
Carbohydrate intolerance of varying degree of
severity with onset or first recognition during
pregnancy,
? Incidence
1%-2% (our country); 1%-10% (other
countries)
The impact of pregnancy on DM
? The first half of pregnancy
1,Relative insulin sensitivity,insulin requirement↓
2,Morning sickness,hypoglycemia
? The latter half of pregnancy
1,Increased insulin resistance,placental hormones↑
2,Intake↓intrapartum,hypoglycemia
3,Postpartum,placental hormones↓→hypoglycemia
Effects on mother and fetus
? Effects on monther
1,Spontaneous abortion
2,Preeclampsia
3,Infection,urinary infection
4,Polyhydramnios (羊水过多 )
5,Fetal macrosomia(巨大儿 ),dystocia(难产 )
6,Ketoacidosis (酮症酸中毒 )
Effects on mother and fetus
? Effects on fetus
1,Fetal macrosomia
2,Fetal growth restriction
3,Premature labor
4,Fetal malformation
? Effects on infant
1,RDS
2,Hypoglycemia
Diagnosis
? Diabetes mellitus complicating pregnancy
Already diagnosed or easy to be diagnosed
? GDM
1,History
Family history of DM,urine glucose
repeatedly (+),recurrent abortion or fetal
death,candidal vaginitis(假丝酵母菌阴道炎 )
Diagnosis
2,Lab examination
1) fasting plasma glucose(空腹血糖 ),
≥5.8mmol/L twice or more
2) glucose screening test 糖筛查 (50g glucose)
1 hr postchallenge ≥7.8mmol/L→ oral glucose
tolerance test,OGTT糖耐量
Diagnosis
3) OGTT (75g glucose)
Any two or more plasma glucose values exceed
the following thresholds→ GDM
1 hr postchallenge,5.6 mmol/L
2 hr postchallenge,10.5 mmol/L
3 hr postchallenge,9.2 mmol/L
4 hr postchallenge,8.0 mmol/L
One value exceed the threshold→ abnormal
glucose tolerance
Classification
? White’s classification of DM in pregnancy
A1,gestational diabetes not requiring insulin
A2,gestational diabetes requiring insulin
B,onset at ≥20 years of age or duration of <10 years
C,onset at 10 to 19 years of age or duration of ≥20 years or any onset or
duration but with background retinopathy视网膜病 or hypertension
only
F,nephropathy 肾病 (>500mg proteinuria per day at <20 weeks of
pregnancy)
H,arteriosclerotic动脉粥样硬化 heart disease,clinically evident
R,proliferative diabetic retinopathy or vitreous hemorrhage玻璃体出
血
T,history of renal transplant
Treatment
? Conception should be prevented in the patients
with class D or F or R DM
? Diet management
1,Meal plans,individualized
2,Calories,30 to 35 cal/kg (ideal body weight,IBW)
per day,carbohydrates 40%-45%,protein 20%-
30%,fat 30%
3,Concentrated sweets,forbidden
4,Six meals per day,2 to 3 hr apart
5,The adequacy of calories intake may be assessed
by using daily fasting urinary ketone levels
Treatment
? Medication (insulin)
1,2g glucose → 1 u insulin
2,Early pregnancy,insulin↓
3,Late pregnancy,insulin ↑ 50%-100%,
peaking at 32 to 33 weeks
4,Postpartum,insulin↓ 1/3-1/2
5,Ketoacidosis,low-dose insulin,0.1U/kg.h
Treatment
? Maternal antepartum care,plasma glucose,
renal function,blood pressure
? Fetal surveillance,development of fetus,
placental function,maturity of fetus
? Termination of pregnancy
1) With other obstetric problems → CS
2) Keeping electrolytical balance
3) Intrapartum,preventing hypoglycemia
4) Postpartum,reducing the dose of insulin,
preventing infection
END
Liu Wei
Department of Ob & Gy
Ren Ji hospital
General Consideration
? Diabetes mellitus complicating pregnancy
Diabetes mellitus is diagnosed before this
pregnancy
? Gestational diabetes mellitus (GDM)
Carbohydrate intolerance of varying degree of
severity with onset or first recognition during
pregnancy,
? Incidence
1%-2% (our country); 1%-10% (other
countries)
The impact of pregnancy on DM
? The first half of pregnancy
1,Relative insulin sensitivity,insulin requirement↓
2,Morning sickness,hypoglycemia
? The latter half of pregnancy
1,Increased insulin resistance,placental hormones↑
2,Intake↓intrapartum,hypoglycemia
3,Postpartum,placental hormones↓→hypoglycemia
Effects on mother and fetus
? Effects on monther
1,Spontaneous abortion
2,Preeclampsia
3,Infection,urinary infection
4,Polyhydramnios (羊水过多 )
5,Fetal macrosomia(巨大儿 ),dystocia(难产 )
6,Ketoacidosis (酮症酸中毒 )
Effects on mother and fetus
? Effects on fetus
1,Fetal macrosomia
2,Fetal growth restriction
3,Premature labor
4,Fetal malformation
? Effects on infant
1,RDS
2,Hypoglycemia
Diagnosis
? Diabetes mellitus complicating pregnancy
Already diagnosed or easy to be diagnosed
? GDM
1,History
Family history of DM,urine glucose
repeatedly (+),recurrent abortion or fetal
death,candidal vaginitis(假丝酵母菌阴道炎 )
Diagnosis
2,Lab examination
1) fasting plasma glucose(空腹血糖 ),
≥5.8mmol/L twice or more
2) glucose screening test 糖筛查 (50g glucose)
1 hr postchallenge ≥7.8mmol/L→ oral glucose
tolerance test,OGTT糖耐量
Diagnosis
3) OGTT (75g glucose)
Any two or more plasma glucose values exceed
the following thresholds→ GDM
1 hr postchallenge,5.6 mmol/L
2 hr postchallenge,10.5 mmol/L
3 hr postchallenge,9.2 mmol/L
4 hr postchallenge,8.0 mmol/L
One value exceed the threshold→ abnormal
glucose tolerance
Classification
? White’s classification of DM in pregnancy
A1,gestational diabetes not requiring insulin
A2,gestational diabetes requiring insulin
B,onset at ≥20 years of age or duration of <10 years
C,onset at 10 to 19 years of age or duration of ≥20 years or any onset or
duration but with background retinopathy视网膜病 or hypertension
only
F,nephropathy 肾病 (>500mg proteinuria per day at <20 weeks of
pregnancy)
H,arteriosclerotic动脉粥样硬化 heart disease,clinically evident
R,proliferative diabetic retinopathy or vitreous hemorrhage玻璃体出
血
T,history of renal transplant
Treatment
? Conception should be prevented in the patients
with class D or F or R DM
? Diet management
1,Meal plans,individualized
2,Calories,30 to 35 cal/kg (ideal body weight,IBW)
per day,carbohydrates 40%-45%,protein 20%-
30%,fat 30%
3,Concentrated sweets,forbidden
4,Six meals per day,2 to 3 hr apart
5,The adequacy of calories intake may be assessed
by using daily fasting urinary ketone levels
Treatment
? Medication (insulin)
1,2g glucose → 1 u insulin
2,Early pregnancy,insulin↓
3,Late pregnancy,insulin ↑ 50%-100%,
peaking at 32 to 33 weeks
4,Postpartum,insulin↓ 1/3-1/2
5,Ketoacidosis,low-dose insulin,0.1U/kg.h
Treatment
? Maternal antepartum care,plasma glucose,
renal function,blood pressure
? Fetal surveillance,development of fetus,
placental function,maturity of fetus
? Termination of pregnancy
1) With other obstetric problems → CS
2) Keeping electrolytical balance
3) Intrapartum,preventing hypoglycemia
4) Postpartum,reducing the dose of insulin,
preventing infection
END
