Diabetes in pregnancyDiabetes in pregnancy

Zohar Nachum, MDZohar Nachum, MDDirector ofDirector of

Maternal-Fetal Medicine UnitMaternal-Fetal Medicine UnitOb&Gyn DeptOb&Gyn Dept

Ha’Emek Med Center, AfulaHa’Emek Med Center, Afula

Case

25 yr old, 6 yr DMConsultation before pregnancyType of DM – type 1Complications – workupThyroid function testsFolic acid

Glucose controlGlucose control

Glucose ControlGlucose Control

Glucose profile, SC sensor, IV sensor

DietInsulinOral hypoglycemicsMultiple injections vs pumpInsulin analogsTight control – prevention of

complications vs hypoglycemia95 – 120 - 95

First trimesterFirst trimesterComplications – abortions, malformationsNTHypoglycemia, diabetic ketoacidosisClass – control, compliance, vasculopathy

Second trimesterSecond trimester

Targeted US – 15 w, 22 wTTLearning disabilities in school

Third trimesterThird trimester

GDM – GCT - OGTT – 105 – 190 – 165 –

145 - 95 - 180 - 155 – 140

PTD - steroidsGrowth – LGA, SGATesting – NST, BPP, Doppler, OCT

DeliveryDelivery

38 w – EFW – clinical, US - > 4000 gr – CS - PV - 3700 – 3999 – induction

Glucose control during labor and delivery

Post Partum - childPost Partum - child

Neonatal complications – RDSHypoglycemiaHyperbilirubinemiaPolycytemiaHypocalcemia, hypomagnesemia

Long term – Obesity, DM, learning disabilities

Post Partum - motherPost Partum - mother

HypoglycemiaDM – post GDM - later in lifeNext pregnancy - GDMContraception – combined OC, IUD,

progestin only

Diabetic named Ruth began to inject“The conventional way – should I reject?”“The answer is clear as a doveThe treatment is like making loveThe intestifued way gets the best effect…”

SummarySummary

Thank you Thank you