Diabetes in Pregnancy

Size: px
Start display at page:

Download "Diabetes in Pregnancy"

Transcription

1 Disclosure Diabetes in Pregnancy I have no conflicts of interest to disclose Jennifer Krupp, MD Maternal Fetal Medicine St. Marys Hospital/SSM Health Madison, WI Objectives Classification of Diabetes Classifications of Diabetes Diagnosis of Maternal & Fetal Morbidity Preconception Counseling Antepartum, Intrapartum and Post Partum Management Pregestational Diabetes Mellitus Type 1 Type 2 A1 diet controlled A2 requires medication Type 1 Diabetes Mellitus Type 2 Diabetes Mellitus Chronic Autoimmune disease Natural History 3 stages 1. Pancreatic beta-cell injury mediated by humoral and cellular activity 2. Pre-diabetic stage progressive islet cell destruction in the pancreas 3. Overt diabetes stage -inadequate insulin production by the islet cell-depleted pancreas leads to severe metabolic consequences. Natural History 5 stages 1. Tissue insulin-resistance insulin resistance in muscle and adipose tissue leads to altered tissue glucose uptake and hyperglycemia 2. Glucotoxicity hyperglycemia directly inhibits glucose uptake into target cells by down regulating the glucose transporter system. 3. Lipotoxicity insulin resistance leads to increased lipolysis in the visceral fat. 4. Impaired glucose tolerance fasting hyperglycemia present, glucotoxicity and lipotoxicity are ongoing. 5. Overt diabetes blood glucose elevated in fasting and postprandial state. Meet diagnosis criteria by ADA 1

2 Mellitus Arises from significant insulin resistance In many cases, preclinical Type 2 DM is unmasked by hormonal stress of pregnancy Complicates 2.5% of pregnancies (135,000 cases annually) Maternal Glucose Regulation Hypoglycemia between meals and at night due to fetus drawing glucose from maternal bloodstream Progressive insulin resistance requires increase in insulin production to 2x prepregnant levels Failure to augment pancreatic insulin output maternal & fetal hyperglycemia Maternal Morbidity Maternal Morbidity Relative risk of morbidity is proportional to the duration and severity of disease Retinopathy Nephropathy Cardiovascular Complications Chronic HTN Preeclampsia Heart Disease Retinopathy Leading cause of blindness ages 24-64yo Present in 100% women with DM > 25 years Pregnancy accelerates these changes Prospective study -50% of patients experienced deterioration during pregnancy all had partial regression PP returned to prepregnancystate by 6 months PP Screen prior to pregnancy & 1st trimester Minimal disease reexamine 1-2 x during pregnancy Significant disease reexamine monthly Maternal Morbidity Maternal Morbidity Nephropathy 20-30% of patients with Type 1 or 2 DM develop nephropathy over time Pregnancy does not alter time course of renal disease Progression is related to duration of diabetes & glycemic control Normal pregnancy increase in renal blood flow and GFR by 30-50% 3rd trimester MAP and PVR rise, women with diabetic microvascular disease marked decrease of renal function, worsened HTN & preeclampsia Increased BP & rapid decrease creatinine clearance PTD to avoid renal failure and stroke End-Stage Renal Disease Prognosis of pregnancy in women with ESRD is poor 60% premature delivery 20% end in live births 40% with severe IUGR Difficult to manage increased vascular volume of pregnancy with dialysis IUGR Best strategy is to undergo renal transplant prior to pregnancy 2

3 Maternal Morbidity Maternal Morbidity Cardiovascular Complications - Chronic HTN BP >140/90 before 20 weeks In 10-20% pregnant women with diabetes In 40% of those with preexisting renal or retinal vascular disease Suspect if BP>130/80 before 3rd trimester Diagnosis strengthened by: Failure of mean BP to decrease in 2nd trimester Creatinine >1mg/dL Cardiovascular Complications- Preeclampsia Occurs 2-3 times more in women with pregestational diabetes Longer duration of DM increased risk of preeclampsia 30% of women with DM >20 years develop preeclampsia Assess renal function each trimester Maternal Morbidity Cardiovascular Complications Preclinical cardiomyopathy and autonomic neuropathy may be present in patient with DM Arteriosclerotic heart disease may be seen in women in their 40 s Pregnancy outcome is poor 50% maternal mortality 30% fetal loss rate Obtain cardiac history, ECG, Echo in patients >30 years old or have had DM >10 years Spontaneous Abortion Congenital Anomalies IUGR Fetal Obesity Birth Injury Abnormal Maternal Glucose Regulation and Fetal Morbidity Elevated PP BG fetal hyperglycemia & hyperinsulinemia increased storage of excessive nutrients macrosomia Increased catabolism of extra nutrients uses energy depleted fetal oxygen stores fetal hypoxia Fetal hypoxia increased release of adrenal catecholamines HTN, cardiac remodeling & hypertrophy, increased Hct due to stimulation of erythropoietin & red cell hyperplasia Congenital Anomalies General pop. risk of major birth defect 1-2% Hgb A1C - preconception 3.4% rate of anomaly if HgbA1C <8.5% 22.4% rate of anomaly if HgbA1C >8.5% Majority of anomalies involve CNS Cardiovascular system 3

4 Intrauterine Growth Restriction In preconception diabetic pregnancies due to underlying maternal vascular disease Asymmetric IUGR in patients with vasculopathy (retinal, renal or CHTN) Brittle control frequent episodes of ketosis and hypoglycemia preeclampsia & poor fetal growth Poor placental function/blood flow IUGR Fetal Overgrowth (Macrosomia) Increased 3-fold in diabetic pregnancies Fetal macrosomia: EFW >4500g Skeletal growth unaffected Adipose accumulation in 3rd trimester Excessive and distributed in truncal region Fetal fat deposition occurs after 28 weeks Pathophysiology of Fetal Overgrowth Maternal Obesity Women with BMI >40 have 3 fold risk of having a fetus with macrosomia 50% increased risk of macrosomia when patient is >300 pounds Fetal birth weight correlates with 2nd & 3rd trimester postprandial blood glucose levels 2 hrpp <120mg/dL20% were macrosomic 2 hr PP mg/dL 35% were macrosomic Shoulder Dystocia Most injuries due to difficult vaginal delivery and shoulder dystocia Shoulder dystocia occurs in % of vaginal deliveries in normal pregnancy Brachial plexus injury Facial Nerve Injury Fetal weight > 4000 grams risk 5-7% Much higher risk if forceps or vacuum used Hypertrophic & Congestive Cardiomyopathy Prevalence 30% at birth; resolution by 1 year Cardiac dysfunction respiratory distress Often asymptomatic & unrecognized Echo hypercontractile, thickened myocardium with septal hypertrophy Pathogenesis is unclear Respiratory Distress Syndrome Neonates of diabetic moms are 20x more likely to develop RDS Distress may be due to decreased production of alveolar surfactant Fetal lung maturity occurs later in pregnancy with poor glycemic control 4

5 Preconception Counseling Preconception Counseling Goals: Decreases morbidity & mortality of mom & fetus Provide prognostic information, taking into account glycemic, cardiovascular, renal and eye status Provide advice re: risks & alternatives to medications the woman is taking Provide direct management to normalize preconception glucose levels & Hgb A1C Hypertension HTN in 20-30% of women who have had diabetes >10 years ACE inhibitors improve proteinuria & delay progression to renal failure in women with nephropathy ACE inhibitors decreased fetal renal blood flow oligohydramnios & fetal renal failure when used in 2nd or 3rd trimester Need to discontinue ACE during preconception period Diagnosis of Antidiabetic Oral Therapy Insulin Therapy Postpartum Management Diagnosis ACOG recommendations: Screening in general population at weeks Option 1 50 gram 1-hour oral glucose tolerance test Cutoff 130 mg/dlor 140 mg/dl If >200 mg/dl, then no further testing 100 gram 3-hour oral glucose tolerance test Option 2 not supported by ACOG 75 gram 2-hour oral glucose tolerance test Cutoff Fasting 92; 1 hour 180; 2 hour abnormal = GDM Diagnosis 3 hour GTT No comparative studies that show significant difference between the two ACOG states can use either one 2 abnormal values = GDM Diagnosis ACOG recommends early screening in high risk populations History of GDM in previous pregnancy Known impaired glucose metabolism BMI >30 These patients screened in 1st Trimester If negative, retest at weeks gestation 5

6 Diabetes Screening and Diagnosis Treatment Management with Diet A1 GDM Management with Medication A2 GDM Oral antidiabetic agents Glyburide Metformin Insulin Therapy Fast acting Long acting American Diabetes Association 2018 Clinical Practice Recommendations First trimester maternal serum screening Level II fetal anatomy ultrasound at 20 weeks gestation Blood sugar monitoring A1GDM serial fetal growth ultrasounds every 4 weeks beginning at 28 weeks gestation A2GDM serial fetal growth ultrasounds every 4 weeks beginning at 28 weeks gestation Antenatal testing with NST beginning at 32 weeks gestation Delivery in 39th week of gestation Option of scheduled cesarean section if EFW > 4500 grams Pregestational Diabetes Baseline preeclampsia studies in 1st Trimester Hemoglobin A1c each trimester Serial fetal growth evaluation every 4 weeks beginning at 28 weeks gestation Fetal surveillance beginning at 32 weeks gestation NST Biophysical profile Delivery in the 39th week of gestation Option of cesarean section if EFW >4500 grams Intensive intrapartum insulin management Postpartum Management Screening 6 weeks postpartum Fasting blood sugar 75 gram 2-hour oral glucose tolerance test ADA recommends repeat testing at least every 3 years Pregestational Diabetes Insulin requirements decrease rapidly after delivery Should have plan for insulin dosage postpartum Breastfeeding Need to increase caloric intake 500kcal/day more than prepregnancy caloric intake Small snacks before and after breastfeeding 6

Management of Pregestational and Gestational Diabetes Mellitus

Management of Pregestational and Gestational Diabetes Mellitus Background and Prevalence Management of Pregestational and Gestational Diabetes Mellitus Pregestational Diabetes - 8 million women in the US are affected, complicating 1% of all pregnancies. Type II is

More information

Diabetes: The Effects of Maternal Diabetes on Fetal Development and Outcomes Sherrie McElvy, MD May 18, 2016

Diabetes: The Effects of Maternal Diabetes on Fetal Development and Outcomes Sherrie McElvy, MD May 18, 2016 Diabetes: The Effects of Maternal Diabetes on Fetal Development and Outcomes Sherrie McElvy, MD May 18, 2016 Medical Director Sweet Success Sutter Medical Center Sacramento Perinatal Associates of Sacramento

More information

Diabetes in Pregnancy. L.Sekhavat MD

Diabetes in Pregnancy. L.Sekhavat MD Diabetes in Pregnancy L.Sekhavat MD Diabetes in Pregnancy Gestational Diabetes Pre-gestational diabetes (overt) Insulin dependent (type1) Non-insulin dependent (type 2) Definition Gestational diabetes

More information

Diabetes in Pregnancy

Diabetes in Pregnancy Diabetes in Pregnancy Ebony Boyce Carter, MD, MPH Division of Maternal Fetal Medicine Washington University School of Medicine Disclosures I have no financial disclosures to report. Objectives Review the

More information

Maximizing the Role of WIC Nutritionists in Prevention of DM2 among High Risk Clients ESTHER G. SCHUSTER, MS,RD,CDE

Maximizing the Role of WIC Nutritionists in Prevention of DM2 among High Risk Clients ESTHER G. SCHUSTER, MS,RD,CDE Maximizing the Role of WIC Nutritionists in Prevention of DM2 among High Risk Clients ESTHER G. SCHUSTER, MS,RD,CDE Heavy Numbers Surgeon General report: 68% of adults in U. S. are overweight or obese

More information

Gestational Diabetes Mellitus Dr. Fawaz Amin Saad

Gestational Diabetes Mellitus Dr. Fawaz Amin Saad Gestational Diabetes Mellitus Dr. Fawaz Amin Saad Senior Consultant OB/GYN, Al-Hayat Medical Center, Doha, Qatar DISCLOSURE OF CONFLICT OF INTEREST I am a full-time Employee at Al-Hayat Medical Center.

More information

Pregestational and Gestational Diabetes

Pregestational and Gestational Diabetes Pregestational and Gestational Diabetes Francis S. Nuthalapaty, MD Greenville Health System University of South Carolina School of Medicine - Greenville Case History 30 year old black female presents to

More information

Gestational Diabetes. Benjamin Byers, D.O., FACOG Center for Maternal and Fetal Care Bryan Physician Network

Gestational Diabetes. Benjamin Byers, D.O., FACOG Center for Maternal and Fetal Care Bryan Physician Network Gestational Diabetes Benjamin Byers, D.O., FACOG Center for Maternal and Fetal Care Bryan Physician Network Outline Definition Prevalence Risk factors complications Diagnosis Management Nonpharmacologic

More information

Gestational Diabetes. Gestational Diabetes:

Gestational Diabetes. Gestational Diabetes: Gestational Diabetes Detection and Management Steven Gabbe, MD The Ohio State University Medical Center Gestational Diabetes: Detection and Management Learning Objectives: At the conclusion of this presentation,

More information

2/13/2018. Update on Gestational Diabetes. Disclosure. Objectives. I have no financial conflicts of interest.

2/13/2018. Update on Gestational Diabetes. Disclosure. Objectives. I have no financial conflicts of interest. Update on Gestational Diabetes Lorie M. Harper, MD, MSCI Department of Obstetrics & Gynecology Division of Maternal-Fetal Medicine 2/18/2018 Disclosure I have no financial conflicts of interest. Objectives

More information

Current Trends in Diagnosis and Management of Gestational Diabetes

Current Trends in Diagnosis and Management of Gestational Diabetes Current Trends in Diagnosis and Management of Gestational Diabetes Shreela Mishra, MD Assistant Clinical Professor UCSF Fresno Medical Education Program 2/2/2019 Disclosures No disclosures 2/2/19 Objectives

More information

Vishwanath Pattan Endocrinology Wyoming Medical Center

Vishwanath Pattan Endocrinology Wyoming Medical Center Vishwanath Pattan Endocrinology Wyoming Medical Center Disclosure Holdings in Tandem Non for this Training Introduction In the United States, 5 to 6 percent of pregnancies almost 250,000 women are affected

More information

The New GDM Screening Guidelines. Jennifer Klinke MD, FRCPC Endocrinologist and Co director RCH Diabetes in Pregnancy Program

The New GDM Screening Guidelines. Jennifer Klinke MD, FRCPC Endocrinologist and Co director RCH Diabetes in Pregnancy Program The New GDM Screening Guidelines Jennifer Klinke MD, FRCPC Endocrinologist and Co director RCH Diabetes in Pregnancy Program Disclosures Current participant (RCH site) for MiTy study Metformin in women

More information

Diabetes in Pregnancy

Diabetes in Pregnancy Diabetes in Pregnancy Resident School November 5 2014 Goals Be able to screen for gestational and preexisting diabetes Be able to counsel women on the diagnosis of gestational diabetes Understand glucose

More information

2018 Standard of Medical Care Diabetes and Pregnancy

2018 Standard of Medical Care Diabetes and Pregnancy 2018 Standard of Medical Care Diabetes and Pregnancy 2018 Standard of Medical Care Diabetes and Pregnancy Marjorie Cypress does not have any relevant financial relationships with any commercial interests

More information

Pregnancies complicated by diabetes. Marina Mickleson Nurse Practitioner Midwife CDE

Pregnancies complicated by diabetes. Marina Mickleson Nurse Practitioner Midwife CDE Pregnancies complicated by diabetes Marina Mickleson Nurse Practitioner Midwife CDE Two types Pre gestational Gestational diabetes Both types are on the increase Pre conception work up is imperative for

More information

The Ever-Changing Approaches to Diabetes in Pregnancy

The Ever-Changing Approaches to Diabetes in Pregnancy The Ever-Changing Approaches to Diabetes in Pregnancy Kirsten E. Salmeen, MD Assistant Professor Obstetrics, Gynecology & Reproductive Sciences Maternal-Fetal Medicine I have nothing to disclose. Approaches

More information

Objectives. Diabetes and Obesity in Pregnancy. In Diabetes. Diabetes in Pregnancy

Objectives. Diabetes and Obesity in Pregnancy. In Diabetes. Diabetes in Pregnancy Objectives Diabetes and Obesity in Pregnancy. Health Impact for the mother and child Bresta Miranda, MD Assistant Professor of Clinical Medicine University of Miami, Miller School of Medicine Review physiologic

More information

Diabetes in Pregnancy

Diabetes in Pregnancy Diabetes in Pregnancy Susan Drummond RN MSN C-EFM Objectives 1. Describe types of diabetes and diagnosis of gestational diabetes 2. Identify a management plan for diabetes during pregnancy 3. Describe

More information

DIABETES WITH PREGNANCY

DIABETES WITH PREGNANCY DIABETES WITH PREGNANCY Prof. Aasem Saif MD,MRCP(UK),FRCP (Edinburgh) Maternal and Fetal Risks Diabetes in pregnancy is associated with risks to the woman and to the developing fetus. Maternal and Fetal

More information

Improving Outcomes in Pregnancies Complicated by Diabetes Mellitus

Improving Outcomes in Pregnancies Complicated by Diabetes Mellitus Improving Outcomes in Pregnancies Complicated by Diabetes Mellitus Steven G. Gabbe, M.D. Emeritus Chief Executive Officer Professor, Obstetrics and Gynecology The Ohio State University Wexner Medical Center

More information

Pregnancy confers a state of insulin resistance and hyperinsulinemia that. Gestational Diabetes Mellitus MANAGEMENT REVIEW

Pregnancy confers a state of insulin resistance and hyperinsulinemia that. Gestational Diabetes Mellitus MANAGEMENT REVIEW MANAGEMENT REVIEW Gestational Diabetes Mellitus Amanda Bird Hoffert Gilmartin, Serdar H. Ural, MD, John T. Repke, MD Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Penn State

More information

GESTATIONAL DIABETES TESTING AND TREAMENT

GESTATIONAL DIABETES TESTING AND TREAMENT Boston Medical Center Maternity Care Guideline: GESTATIONAL DIABETES TESTING AND TREAMENT Accepted: August 2015 Updated: December 2018 Contributors: Aviva Lee-Parritz, MD, Sara Alexanian, MD, Kari Radoff,

More information

APEC Guidelines Gestational Diabetes Mellitus

APEC Guidelines Gestational Diabetes Mellitus Gestational diabetes mellitus (GDM) is defined as insulin resistance of variable severity with onset or first recognition during pregnancy. The prevalence of diabetes mellitus (DM) in the US is growing

More information

Gestational Diabetes: Long Term Metabolic Consequences. Outline 5/27/2014

Gestational Diabetes: Long Term Metabolic Consequences. Outline 5/27/2014 Gestational Diabetes: Long Term Metabolic Consequences Gladys (Sandy) Ramos, MD Associate Clinical Professor Maternal Fetal Medicine Outline Population rates of obesity and T2DM Obesity and metabolic syndrome

More information

CommUnityCare Women s Health Brackenridge Professional Office Building

CommUnityCare Women s Health Brackenridge Professional Office Building Guidelines for Diabetes in Pregnancy Effective Date 7/1/11 *This document does not define a standard of care, nor is it intended to dictate an exclusive course of management. There are other accepted strategies

More information

during pregnancy. any degree of impaired glucose intolerance 11/19/2012 Prevalence & Diagnosis of Gestational Diabetes

during pregnancy. any degree of impaired glucose intolerance 11/19/2012 Prevalence & Diagnosis of Gestational Diabetes Prevalence & Diagnosis of Gestational Diabetes A.Ziaee, MD Endocrinologist Gestational diabetes mellitus (GDM); any degree of impaired glucose intolerance with onset or first recognition during pregnancy.

More information

Diabetes: Definition Pathophysiology Treatment Goals. By Scott Magee, MD, FACE

Diabetes: Definition Pathophysiology Treatment Goals. By Scott Magee, MD, FACE Diabetes: Definition Pathophysiology Treatment Goals By Scott Magee, MD, FACE Disclosures No disclosures to report Definition of Diabetes Mellitus Diabetes Mellitus comprises a group of disorders characterized

More information

Data from birth certificates in the United

Data from birth certificates in the United Chapter 36 Pregnancy in Preexisting Diabetes Thomas A. Buchanan, M.D. SUMMARY Data from birth certificates in the United States indicate that maternal diabetes complicates 2%-3% of all pregnancies, but

More information

DIABETES AND PREGNANCY. CDE Exam Preparation March 22 & 27, 2018 Presented by Wendy Graham RD CDE Mentor

DIABETES AND PREGNANCY. CDE Exam Preparation March 22 & 27, 2018 Presented by Wendy Graham RD CDE Mentor DIABETES AND PREGNANCY CDE Exam Preparation March 22 & 27, 2018 Presented by Wendy Graham RD CDE Mentor OBJECTIVES Describe targets for blood glucose in pregnancy Discuss the risks to baby if blood glucose

More information

Objectives. Medical Complications of Pregnancy. Potential Conflicts: None. Common Complicating Medical Conditions that Precede Pregnancy

Objectives. Medical Complications of Pregnancy. Potential Conflicts: None. Common Complicating Medical Conditions that Precede Pregnancy Medical Complications of Potential Conflicts: None Ellen W. Seely, M.D. Director of Clinical Research Endocrine-Hypertension Division Brigham and Women s Hospital Professor of Medicine Harvard Medical

More information

SCREENING FOR DIABETES IN THE FIRST TRIMESTER: WHY & HOW? Jillian Coolen, MD FRCSC DCPNS Spring Conference April 21, 2016

SCREENING FOR DIABETES IN THE FIRST TRIMESTER: WHY & HOW? Jillian Coolen, MD FRCSC DCPNS Spring Conference April 21, 2016 SCREENING FOR DIABETES IN THE FIRST TRIMESTER: WHY & HOW? Jillian Coolen, MD FRCSC DCPNS Spring Conference April 21, 2016 DISCLOSURE Site investigator for the CONCEPTT study funded by Juvenile Diabetes

More information

Diagnosis and Management of Gestational Diabetes Mellitus. Prof. Dr Md Faizul Islam Chowdhury Professor of Medicine, Department of Medicine, DMCH.

Diagnosis and Management of Gestational Diabetes Mellitus. Prof. Dr Md Faizul Islam Chowdhury Professor of Medicine, Department of Medicine, DMCH. Diagnosis and Management of Gestational Diabetes Mellitus Prof. Dr Md Faizul Islam Chowdhury Professor of Medicine, Department of Medicine, DMCH. Gestational Diabetes Mellitus I, the Fetus I, the fetus

More information

Diabetes Related Disclosures

Diabetes Related Disclosures Diabetes Related Disclosures Speakers Bureau Amylin Boehringer Ingelheim Eli Lilly Takeda Classification of Diabetes Diabetes Care January 2011 vol. 34 no. Supplement 1 S11-S61 Type 1 Diabetes Mellitus

More information

Managing Diabetes Before, During, and After Pregnancy

Managing Diabetes Before, During, and After Pregnancy Managing Diabetes Before, During, and After Pregnancy This program is supported by an educational grant from Novo Nordisk Inc. It has been accredited by AADE for pharmacists, nurses, and dietitians. This

More information

Management of Gestational Diabetes

Management of Gestational Diabetes Management of Gestational Diabetes A Diabetes risk assessment should be ascertained at the First prenatal visit. Low Risk: Early blood glucose screening is NOT routinely required if most of the following

More information

Diabetes in obstetric patients

Diabetes in obstetric patients Diabetes in obstetric patients Swedish Society of Obstetric Anaesthesia & Intensive Care Anita Banerjee Obstetric Physician Diabetes & Endocrinology Consultant Outline Scope of the problem Diabetes and

More information

Pregnancy outcomes in Korean women with diabetes

Pregnancy outcomes in Korean women with diabetes Pregnancy outcomes in Korean women with diabetes Sung-Hoon Kim Department of Medicine, Cheil General Hospital & Women s Healthcare Center, Dankook University College of Medicine, Seoul, Korea Conflict

More information

Pregestational Diabetes in Pregnancy. An Update

Pregestational Diabetes in Pregnancy. An Update Pregestational Diabetes in Pregnancy An Update Disclosures D. Ware Branch, MD Nothing to disclose Questions to Be Addressed What are risks factors for adverse pregnancy outcome in pregestational diabetes?

More information

Medical Complications of Pregnancy

Medical Complications of Pregnancy Medical Complications of Pregnancy Systems Cardiovascular Pulmonary Endocrine Gastrointestinal Urologic Neurologic Cardiovascular System Physiologic anemia 3:1 increase of plasma volume:rbc mass Treat

More information

Counseling and Long-term Follow up After Gestational Disorders

Counseling and Long-term Follow up After Gestational Disorders Counseling and Long-term Follow up After Gestational Disorders Tanya Melnik, MD Assistant Professor, University of Minnesota Sarina Martini, MD Ob/Gyn Resident, PGY4 University of Minnesota Counseling

More information

Effect of Gestational Diabetes mellitus Health Education Module on Pregnancy Outcomes

Effect of Gestational Diabetes mellitus Health Education Module on Pregnancy Outcomes World Journal of Nursing Sciences 1 (3): 76-88, 2015 ISSN 2222-1352 IDOSI Publications, 2015 DOI: 10.5829/idosi.wjns.2015.76.88 Effect of Gestational Diabetes mellitus Health Education Module on Pregnancy

More information

Maternal Child Health and Chronic Disease

Maternal Child Health and Chronic Disease Maternal Child Health and Chronic Disease The Odd Couple or A Marriage Made in Heaven? AMCHP Women and Perinatal Health Information Series July 17, 2008 Joan Ware, MSPH, RN, Consultant, Women s s Health

More information

Disclosures. Diagnosis and Management of Diabetes in Pregnancy. I have nothing to disclose. Type 1. Overview GDMA1

Disclosures. Diagnosis and Management of Diabetes in Pregnancy. I have nothing to disclose. Type 1. Overview GDMA1 Diagnosis and Management of Diabetes in Pregnancy Kirsten Salmeen, MD Assistant Professor Department of Obstetrics, Gynecology & Reproductive Sciences Maternal-Fetal Medicine Disclosures I have nothing

More information

Comparative Study between Acarbose and Insulin in the Treatment of GDM.

Comparative Study between Acarbose and Insulin in the Treatment of GDM. Original Article DOI: 10.21276/aimdr.2018.4.2.OG5 ISSN (O):2395-2822; ISSN (P):2395-2814 Comparative Study between Acarbose and Insulin in the Treatment of GDM. Minthami Sharon 1, Niloufur Syed Bashutheen

More information

Diabetes in Pregnancy

Diabetes in Pregnancy JSAFOG Diabetes in Pregnancy CONTEMPORARY REVIEW ARTICLE Diabetes in Pregnancy Neeta Deshpande Consultant, Diabetologist and Bariatric Physician, Belgaum Diabetes Center, Belgaum, Karnataka, India Correspondence:

More information

Significant economic burden Conservative because focus on near-term medical costs, omitting increased long-term risks Insulin Resistance

Significant economic burden Conservative because focus on near-term medical costs, omitting increased long-term risks Insulin Resistance What s New in Gestational Diabetes? Diane Reader RD, CDE International Diabetes Center Park Nicollet Health Services Minneapolis, MN GDM Statistics What s New? Proposed Changes to Diagnostic Criteria Treatment

More information

Diabetes in Pregnancy: Detection, Intervention, Prevention. Diabetes in Pregnancy: Outline. Diabetes in Pregnancy

Diabetes in Pregnancy: Detection, Intervention, Prevention. Diabetes in Pregnancy: Outline. Diabetes in Pregnancy Diabetes in Pregnancy: Detection, Intervention, Prevention Michael Shannon, MD Chair, Providence Endocrinology/Diabetes CAT Diabetes in Pregnancy: Outline Prevalence, Pathophysiology and Complications

More information

Hypoglycemia. Objectives. Glucose Metabolism

Hypoglycemia. Objectives. Glucose Metabolism Hypoglycemia Instructor: Janet Mendis, MSN, RNC-NIC, CNS Outline: Janet Mendis, MSN, RNC-NIC, CNS Summer Morgan, MSN, RNC-NIC, CPNP UC San Diego Health System Objectives State the blood glucose level at

More information

PREGESTATIONAL DIABETES (TYPE 1 AND 2)

PREGESTATIONAL DIABETES (TYPE 1 AND 2) PREGESTATIONAL DIABETES (TYPE 1 AND 2) Women with diabetes prior to pregnancy need to evaluate and optimize their baseline to assure the healthiest pregnancy possible.[1] The overall prevalence of pregnant

More information

Infant Of Diabetic Mother(IDM)

Infant Of Diabetic Mother(IDM) Infant Of Diabetic Mother(IDM) Sangram Satish Magar 1, Sanskriti Mirashi 2 1. M.D. Sch.(Kaumarbhrutya-Balrog) 2.Guide (Kaumarbhrutya-Balrog), L.R.P.Medical college,islampur,tal- Walwa, dist- Sangli, Maharashtra,

More information

Diabetes in Pregnancy: The Risks For Two Patients

Diabetes in Pregnancy: The Risks For Two Patients Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/the-connect-dialogues/diabetes-in-pregnancy-the-risks-for-twopatients/1793/

More information

Gestational Diabetes in Resouce. Prof Satyan Rajbhandari (RAJ)

Gestational Diabetes in Resouce. Prof Satyan Rajbhandari (RAJ) Gestational Diabetes in Resouce Limited Area Prof Satyan Rajbhandari (RAJ) Case History RP, 26F Nepali girl settled in the UK Primi Gravida BMI: 23 FH of type 2 DM 75 gm Glucose OGTT in week 25 0 Min

More information

Gestational Diabetes: An Update on Testing. Kimberlee A McKay, M.D. Avera Medical Group Ob/GYN

Gestational Diabetes: An Update on Testing. Kimberlee A McKay, M.D. Avera Medical Group Ob/GYN Gestational Diabetes: An Update on Testing Kimberlee A McKay, M.D. Avera Medical Group Ob/GYN Gestational Diabetes Increased risks of: Still Birth Hydramnios Should Dystocia Prolonged Labor Preeclampsia

More information

Diabetes in Pregnancy Dr. Hana

Diabetes in Pregnancy Dr. Hana Diabetes in Pregnancy Dr. Hana Introduction Diabetes occurs in 2 5% of all UK pregnancies and its prevalence is rising. Forty years ago the majority of women with diabetes attending an antenatal clinic

More information

What is Diabetes Mellitus?

What is Diabetes Mellitus? Normal Glucose Metabolism What is Diabetes Mellitus? When the amount of glucose in the blood increases, After a meal, it triggers the release of the hormone insulin from the pancreas. Insulin stimulates

More information

Peripartum and Postpartum Management of Diabetes

Peripartum and Postpartum Management of Diabetes Peripartum and Postpartum Management of Diabetes General Principles Glucose goal ~ 100 mg/dl (70-110 mg/dl) Labor is EXERCISE with increased metabolic demands. Insulin requirements decrease however the

More information

PRE GESTATIONAL DIABETES. Conflicts

PRE GESTATIONAL DIABETES. Conflicts PRE GESTATIONAL DIABETES Christopher Goodier, MD Assistant Professor, Maternal Fetal Medicine Medical University of South Carolina Conflicts I have no relevant disclosures or conflict of interest with

More information

A Study of Gestational Diabetes in Patients in a Tertiary Care Hospital in Hyderabad Telangana State, India

A Study of Gestational Diabetes in Patients in a Tertiary Care Hospital in Hyderabad Telangana State, India International Journal of Current Microbiology and Applied Sciences ISSN: 2319-7706 Volume 6 Number 10 (2017) pp. 2586-2590 Journal homepage: http://www.ijcmas.com Original Research Article https://doi.org/10.20546/ijcmas.2017.610.304

More information

Intrapartum and Postpartum Management of the Diabetic Mother and Infant

Intrapartum and Postpartum Management of the Diabetic Mother and Infant Intrapartum and Postpartum Management of the Diabetic Mother and Infant Intrapartum Management Women with gestational diabetes who maintain normal glucose levels during pregnancy on diet and exercise therapy

More information

GESTATIONAL DIABETES for GP Obstetric Shared Care Accreditation Seminar. Simon Kane March 2016

GESTATIONAL DIABETES for GP Obstetric Shared Care Accreditation Seminar. Simon Kane March 2016 GESTATIONAL DIABETES for GP Obstetric Shared Care Accreditation Seminar Simon Kane March 2016 Objectives History and definitions Definition and Australian data Pathophysiology and prevalence Rationale

More information

Prevention and Management of Diabetes in Pregnancy

Prevention and Management of Diabetes in Pregnancy Prevention and Management of Diabetes in Pregnancy Sridhar Chitturi Consultant Endocrinologist Royal Darwin Hospital Outline of the talk Diabetes in Pregnancy Spectrum Diagnostic criteria Why bother about

More information

Effect of Various Degrees of Maternal Hyperglycemia on Fetal Outcome

Effect of Various Degrees of Maternal Hyperglycemia on Fetal Outcome ORIGINAL ARTICLE Effect of Various Degrees of Maternal Hyperglycemia on Fetal Outcome ABSTRACT Shagufta Tahir, Shaheen Zafar, Savita Thontia Objective Study design Place & Duration of study Methodology

More information

Reminder: NPIC/QAS CME/CEU Program

Reminder: NPIC/QAS CME/CEU Program V.12.2 Special Report: Perinatal Complications associated with Gestational and Pregestational Diabetes I. Introduction Diabetes mellitus is a metabolic disease characterized by chronic hyperglycemia and

More information

CGM Use in Pregnancy & Unique Populations ELIZABETH O. BUSCHUR, MD THE OHIO STATE UNIVERSITY WEXNER MEDICAL CENTER

CGM Use in Pregnancy & Unique Populations ELIZABETH O. BUSCHUR, MD THE OHIO STATE UNIVERSITY WEXNER MEDICAL CENTER CGM Use in Pregnancy & Unique Populations ELIZABETH O. BUSCHUR, MD THE OHIO STATE UNIVERSITY WEXNER MEDICAL CENTER Case 1: CGM use during pregnancy 29 yo G1P0000 at 10 5/7 weeks gestation presents to set

More information

Guideline for Management of Type 2 Diabetes Mellitus: Kingdome of Bahrain Ministry of Health 2016

Guideline for Management of Type 2 Diabetes Mellitus: Kingdome of Bahrain Ministry of Health 2016 Guideline for Management of Type 2 Diabetes Mellitus: Kingdome of Bahrain Ministry of Health 2016 1. Screening and diagnosis: Detection type 2 Diabetes are usually based on a two-step approach: Step 1:

More information

Pregnancy and Diabetes

Pregnancy and Diabetes Pregnancy and Diabetes Aim(s) and objective(s) This guideline aims to highlight the importance of maintaining good glycaemic control in women of childbearing age contemplating pregnancy, during pregnancy

More information

Clinical features. Abnormal vasculogenesis and angiogenesis and releasing of antiangiogenic

Clinical features. Abnormal vasculogenesis and angiogenesis and releasing of antiangiogenic Clinical features Abnormal vasculogenesis and angiogenesis and releasing of antiangiogenic factors results in Vasospasm Endothelial dysfunction Etiology of various clinical signs and symptoms So, Preeclampsia

More information

Canadian Journal of Diabetes

Canadian Journal of Diabetes Can J Diabetes 42 (2018) S255 S282 Contents lists available at ScienceDirect Canadian Journal of Diabetes journal homepage: www.canadianjournalofdiabetes.com 2018 Clinical Practice Guidelines Diabetes

More information

associated with serious complications, but reduce occurrences with preventive measures

associated with serious complications, but reduce occurrences with preventive measures Wk 9. Management of Clients with Diabetes Mellitus 1. Diabetes Mellitus body s inability to metabolize carbohydrates, fats, proteins hyperglycemia associated with serious complications, but reduce occurrences

More information

Are Novel Lifestyle Approaches to Management of Type 2 Diabetes Applicable to Prevention and Treatment of Women with Gestational Diabetes Mellitus?

Are Novel Lifestyle Approaches to Management of Type 2 Diabetes Applicable to Prevention and Treatment of Women with Gestational Diabetes Mellitus? Open Access Journal Volume: 1.1 Global Diabetes Open Access Journal Are Novel Lifestyle Approaches to Management of Type 2 Diabetes Applicable to Prevention and Treatment of Women with Gestational Diabetes

More information

A S Y N T H E S I Z E D H A N D B O O K ON G E S T A T I O N A L D I A B E T E S

A S Y N T H E S I Z E D H A N D B O O K ON G E S T A T I O N A L D I A B E T E S A S Y N T H E S I Z E D H A N D B O O K ON G E S T A T I O N A L D I A B E T E S P R E F A C E Dear reader, This is a synthesized handbook conceived to serve as a tool to health personnel in the screening,

More information

Highlighting the Differences between Preexisting Type 1 and Type 2 Diabetes in Pregnancy and Gestational Diabetes

Highlighting the Differences between Preexisting Type 1 and Type 2 Diabetes in Pregnancy and Gestational Diabetes Highlighting the Differences between Preexisting Type 1 and Type 2 Diabetes in Pregnancy and Gestational Diabetes Elizabeth (Libby) Downs Quiroga, MS, RD, CDE Tandem Diabetes Care Clinical Specialist Grand

More information

Why do we care? 20.8 million people. 70% of people with diabetes will die of cardiovascular disease. What is Diabetes?

Why do we care? 20.8 million people. 70% of people with diabetes will die of cardiovascular disease. What is Diabetes? What is Diabetes? Diabetes 101 Ginny Burns RN MEd CDE Diabetes mellitus is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action

More information

Objectives. Diabetes in Pregnancy: A Growing Dilemma. Diabetes in the US 10/6/2015. Disclosure. The presenter has no conflicts to disclose

Objectives. Diabetes in Pregnancy: A Growing Dilemma. Diabetes in the US 10/6/2015. Disclosure. The presenter has no conflicts to disclose Diabetes in Pregnancy: A Growing Dilemma Kathy O Connell, MN RN Perinatal Clinical Nurse Specialist University of Washington Medical Center Seattle, WA koconnll@uw.edu Objectives Describe pathophysiologic

More information

Janice Lazear, DNP, FNP-C, CDE DIAGNOSIS AND CLASSIFICATION OF DIABETES

Janice Lazear, DNP, FNP-C, CDE DIAGNOSIS AND CLASSIFICATION OF DIABETES Janice Lazear, DNP, FNP-C, CDE DIAGNOSIS AND CLASSIFICATION OF DIABETES Objectives u At conclusion of the lecture the participant will be able to: 1. Differentiate between the classifications of diabetes

More information

Hormonal Regulations Of Glucose Metabolism & DM

Hormonal Regulations Of Glucose Metabolism & DM Hormonal Regulations Of Glucose Metabolism & DM What Hormones Regulate Metabolism? What Hormones Regulate Metabolism? Insulin Glucagon Thyroid hormones Cortisol Epinephrine Most regulation occurs in order

More information

Pathogenesis of Diabetes Mellitus

Pathogenesis of Diabetes Mellitus Pathogenesis of Diabetes Mellitus Young-Bum Kim, Ph.D. Associate Professor of Medicine Harvard Medical School Definition of Diabetes Mellitus a group of metabolic diseases characterized by hyperglycemia

More information

Neonatal Hypoglycemia. Presented By : Kamlah Olaimat 25\7\2010

Neonatal Hypoglycemia. Presented By : Kamlah Olaimat 25\7\2010 Neonatal Hypoglycemia Presented By : Kamlah Olaimat 25\7\2010 Definition The S.T.A.B.L.E. Program defines hypoglycemia as: Glucose delivery or availability is inadequate to meet glucose demand (Karlsen,

More information

Diabetes in pregnancy

Diabetes in pregnancy Diabetes in pregnancy Bipin Sethi Department of Endocrinology Care Hospitals Hyderabad, India Declared no potential conflict of interest Diabetes in pregnancy Bipin Kumar Sethi Department of Endocrinology,

More information

Managing Gestational Diabetes. Definition of GDM

Managing Gestational Diabetes. Definition of GDM Managing Gestational Diabetes Definition of GDM Gestational diabetes is defined as glucose intolerance of variable severity with onset or first recognition during pregnancy that excludes those with overt

More information

Screening & Management of Diabetes in Pregnancy: What s New?

Screening & Management of Diabetes in Pregnancy: What s New? Screening & Management of Diabetes in Pregnancy: What s New? Jerrie S. Refuerzo, M.D. Associate Professor Division of Maternal Fetal medicine Department of Obstetrics, Gynecology and Reproductive Sciences

More information

Diabetes and Pregnancy

Diabetes and Pregnancy Diabetes and Pregnancy Eric L. Johnson, M.D. Associate Professor Department of Family and Community Medicine University of North Dakota School of Medicine And Health Sciences Assistant Medical Director

More information

Comparison of pregnancy outcome of diabetic and non diabetic pregnancy at rural tertiary hospital in Bangalore

Comparison of pregnancy outcome of diabetic and non diabetic pregnancy at rural tertiary hospital in Bangalore Original article: Comparison of pregnancy outcome of diabetic and non diabetic pregnancy at rural tertiary hospital in Bangalore *Umashankar KM, Dharma Vijay MN, Sudha, Kavitha G,Sushma *Corresponding

More information

MANAGEMENT OF DIABETES IN PREGNANCY

MANAGEMENT OF DIABETES IN PREGNANCY MANAGEMENT OF DIABETES IN PREGNANCY Ministry of Health Malaysia Malaysian Endocrine & Metabolic Society Perinatal Society of Malaysia Family Medicine Specialists Association of Malaysia Academy of Medicine

More information

How to manage a pregnant patient with diabetes

How to manage a pregnant patient with diabetes How to manage a pregnant patient with diabetes EASD Postgraduate Course on Clinical Diabetes and its Complications, Shiraz, Iran Rasa Verkauskiene Lithuanian University of Health Sciences 2017 History

More information

Current Approaches to Caring for the Woman with Diabetes During Pregnancy

Current Approaches to Caring for the Woman with Diabetes During Pregnancy CONTINUING EDUCATION Current Approaches to Caring for the Woman with Diabetes During Pregnancy Julie Daley, RN, MS, CDE Director, Diabetes in Pregnancy Program Women & Infants Hospital of Rhode Island

More information

Diabetes in pregnancy & its management Begum R

Diabetes in pregnancy & its management Begum R The ORION Medical Journal 2008 Jan;29:524-527 Diabetes in pregnancy & its management Begum R Introduction Diabetes mellitus is the most common medical complication of pregnancy and it carries a significant

More information

Screening and Diagnosis of Diabetes Mellitus in Taiwan

Screening and Diagnosis of Diabetes Mellitus in Taiwan Screening and Diagnosis of Diabetes Mellitus in Taiwan Hung-Yuan Li, MD, MMSc, PhD Attending Physician, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan Associate Professor,

More information

COMPLICATIONS OF PRE-GESTATIONAL AND GESTATIONAL DIABETES IN SAUDI WOMEN: ANALYSIS FROM RIYADH MOTHER AND BABY COHORT STUDY (RAHMA)

COMPLICATIONS OF PRE-GESTATIONAL AND GESTATIONAL DIABETES IN SAUDI WOMEN: ANALYSIS FROM RIYADH MOTHER AND BABY COHORT STUDY (RAHMA) COMPLICATIONS OF PRE-GESTATIONAL AND GESTATIONAL DIABETES IN SAUDI WOMEN: ANALYSIS FROM RIYADH MOTHER AND BABY COHORT STUDY (RAHMA) Prof. Hayfaa Wahabi, King Saud University, Riyadh Saudi Arabia Hayfaa

More information

Test Bank for Maternal Child Nursing Care in Canada 1st by Perry Hockenberry Wilson

Test Bank for Maternal Child Nursing Care in Canada 1st by Perry Hockenberry Wilson Test Bank for Maternal Child Nursing Care in Canada 1st by Perry Hockenberry Wilson Chapter 14: Pregnancy at Risk: Pre-Existing Conditions Test Bank MULTIPLE CHOICE 1. In assessing the knowledge of a pregestational

More information

DIABETES MELLITUS IN PREGNANCY; MATERNAL & PRENATAL OUTCOME

DIABETES MELLITUS IN PREGNANCY; MATERNAL & PRENATAL OUTCOME Basrah Journal Of Surgery DIABETES MELLITUS IN PREGNANCY; MATERNAL & PRENATAL OUTCOME Rabia A Alkaban* & Methal A AL-Rubaee @ * MB,ChB. @ MB,ChB, DGO, CABOG, Department of Obstetric & Gynecology, Medical

More information

Optimizing Postpartum Maternal Health to Prevent Chronic Diseases

Optimizing Postpartum Maternal Health to Prevent Chronic Diseases Optimizing Postpartum Maternal Health to Prevent Chronic Diseases Amy Loden, MD, FACP, NCMP Disclosures Research: None Financial: none applicable to this presentation PRIUM QEssentials Market Research

More information

METABOLIC SYNDROME IN REPRODUCTIVE FEMALES

METABOLIC SYNDROME IN REPRODUCTIVE FEMALES METABOLIC SYNDROME IN REPRODUCTIVE FEMALES John J. Orris, D.O., M.B.A Division Head, Reproductive Endocrinology & Infertility, Main Line Health System Associate Professor, Drexel University College of

More information

Common Diabetes-related Terms

Common Diabetes-related Terms Common Diabetes-related Terms A1C An A1C test measures a person's average blood glucose level over two to three months. Hemoglobin is the part of a red blood cell that carries oxygen to the cells and sometimes

More information

HbA1c level in last trimester pregnancy in predicting macrosomia and hypoglycemia in neonate

HbA1c level in last trimester pregnancy in predicting macrosomia and hypoglycemia in neonate International Journal of Contemporary Pediatrics Subash S et al. Int J Contemp Pediatr. 2016 Nov;3(4):1334-1338 http://www.ijpediatrics.com pissn 2349-3283 eissn 2349-3291 Original Research Article DOI:

More information

Chapter 37: Exercise Prescription in Patients with Diabetes

Chapter 37: Exercise Prescription in Patients with Diabetes Chapter 37: Exercise Prescription in Patients with Diabetes American College of Sports Medicine. (2010). ACSM's resource manual for guidelines for exercise testing and prescription (6th ed.). New York:

More information

Week 3, Lecture 5a. Pathophysiology of Diabetes. Simin Liu, MD, ScD

Week 3, Lecture 5a. Pathophysiology of Diabetes. Simin Liu, MD, ScD Week 3, Lecture 5a Pathophysiology of Diabetes Simin Liu, MD, ScD General Model of Peptide Hormone Action Hormone Plasma Membrane Activated Nucleus Cellular Trafficking Enzymes Inhibited Receptor Effector

More information

The GDM Network presents. Diagnosing and Screening for Gestational Diabetes: Still a Controversy? Still a Challenge? June 18, :30-3:00 PM

The GDM Network presents. Diagnosing and Screening for Gestational Diabetes: Still a Controversy? Still a Challenge? June 18, :30-3:00 PM The GDM Network presents Diagnosing and Screening for Gestational Diabetes: Still a Controversy? Still a Challenge? June 18, 2013 1:30-3:00 PM Speakers include: Robert Silver, MD, NIH GDM Panelist Neil

More information

Physical Activity/Exercise Prescription with Diabetes

Physical Activity/Exercise Prescription with Diabetes Physical Activity/Exercise Prescription with Diabetes B R AD H I NTERMEYER C E P A C SM S A NFORD H E ALTH C A RDIAC R E H AB A N D D I ABE TES E XE RCISE The adoption and maintenance of physical activity

More information