Professional Documents
Culture Documents
Diabetes in Pregnancy
Diagnosis and
Classification of Diabetes
in Pregnancy
Scientific Exchanges in Endocrinology and Diabetes
Philippine Society of Endocrinology, Diabetes and
Metabolism
Imelda Soberano-Antonio, MD, FPCP, FPSEDM
Monica Therese Cating-Cabral, MD, FPCP, FPSEDM
Margarita Holgado-Galicia, MD, FPCP, FPSEDM
Cristina Jaring, MD, FPCP, FPSEDM
Paulette Nacpil-Dominguez, MD, FPCP, DPSEDM
Queenie Ngalob Samonte, MD, FPCP, DPSEDM
Learning Objectives
After this session, attendees should be able to:
1. Understand the pathogenesis of diabetes in
pregnancy and its complications in both the
mother and fetus
2. Screen for and diagnose diabetes in
pregnancy
3. Differentiate between pre-gestational
diabetes/overt diabetes and gestational
diabetes mellitus
Outline
Insulin resistance and pregnancy
Classification of diabetes mellitus (DM) in
pregnancy
Complications of DM in pregnancy
Period from conception to birth with
physiologic adaptations to maintain an
environment conducive for the fetus
State of insulin resistance
Mohammed Chyad Al-Noaemi and Mohammed Helmy Faris Shalayel (2011). Pathophysiology of Gestational Diabetes Mellitus:
The Past, the Present and the Future, Gestational Diabetes, Prof. Miroslav Radenkovic (Ed.), ISBN: 978-953-307-581-5, InTech
Increased estrogen,
progesterone
Increased
pancreatic B cell
hyperplasia
Increased insulin
release
Mohammed Chyad Al-Noaemi and Mohammed Helmy Faris Shalayel (2011). Pathophysiology of Gestational Diabetes Mellitus:
The Past, the Present and the Future, Gestational Diabetes, Prof. Miroslav Radenkovic (Ed.), ISBN: 978-953-307-581-5, InTech
Fetoplacental hormones!!!
Decreased maternal insulin
sensitivity
Mohammed Chyad Al-Noaemi and Mohammed Helmy Faris Shalayel (2011). Pathophysiology of Gestational Diabetes Mellitus:
The Past, the Present and the Future, Gestational Diabetes, Prof. Miroslav Radenkovic (Ed.), ISBN: 978-953-307-581-5, InTech
Classification of Diabetes Mellitus (DM)
in Pregnancy
Pre-Existing Pregnancy
Gestational
Pre-Gestational
Diabetes
Diabetes Overt Diabetes
(GDM)
Gestational
Pre-Gestational
Diabetes
Diabetes Overt Diabetes
(GDM)
4-fold increased
risk
Risk rises with
poor glycemic
control
Obstetric
DM Complications
Outcomes
DM Retinopathy
No to mild retinopathy
Small risk for progression
Established retinopathy
can rapidly progress during Effects of pregnancy on
and up to 1 year after retinopathy eventually
pregnancy, more so in diminish after the first year
poorly controlled
DCCT group. Diabetes Care 23:10841091, 2000
Boulot P, et al., Diabetes Care 26:29902993, 2003
D. Thompson et al., Can J Diabetes 37 (2013) S168eS183
Chew EY, et al., Diabetes Care. 1995 May;18(5):6
DM Retinopathy
Patients with higher levels of HBA1C
were at greater risk for progression
Normal creatinine
albuminuria and creatinine
clearance is preserved during
pregnancy
Microalbuminuria
may worsen but typically Moderate to severe
modest and reversible can significantly deteriorate and
(BP and blood sugar are well- may not be reversible
controlled)
Gestational
Pre-Gestational
Diabetes
Diabetes Overt Diabetes
(GDM)
Gestational
Pre-Gestational
Diabetes
Diabetes Overt Diabetes
(GDM)
DM Obstetric
Complications Outcomes
Mrs. R, 22F
PU 24 wks AOG
G2P1
no risk factors
75 gm OGTT at 24wks AOG
FBS : 89 mg/dl
1 hr : 190 mg/dl
2 hr : 150 mg/dl
#1 Diagnosis of GDM
24th to 28th week AOG using 75 gm OGTT
Gestational
Pre-Gestational
Diabetes
Diabetes Overt Diabetes
(GDM)
DM Obstetric
Complications Outcomes
Effect DM on the conceptus
Fetal: Increased birthweight, hypoglycemia, birth
injuries, shoulder dystocia,
NICU admission, hyperbilirubinemia
Children : Abnormal glucose tolerance and
obesity
Effect of DM on the mother
Maternal : Increased cesarean delivery &
preeclampsia
Classification of Diabetes Mellitus (DM)
in Pregnancy
Pre-Existing Pregnancy
Gestational
Pre-Gestational
Diabetes
Diabetes Overt Diabetes
(GDM)