扬州大学：《妇产科学》课程教学课件（PPT讲稿）13 妊娠期糖尿病 Diabetes

Medical ComplicationIn'PregnancyDiabetes

Medical Complication In Pregnancy Diabetes

Atthe beginning of the 20thcentury , diabetic women sufferedfrom infetility, and the rare womenachieving pregnancy faceda poorprognosis.Maternal death was areal threat,and perinatal survival amore4opercent

At the beginning of the 20th century , diabetic women suffered from infetility, and the rare women achieving pregnancy faced a poor prognosis. Maternal death was a real threat,and perinatal survival a more 40 percent

Theavailability of insulinsince 1922restored fertility and virtuallyabolished maternal mortality.At/the sametime,perinatalsurvivaldid not change appreciatably.Since1949WhiteClassificationwasdeveloped, permitted individualizedtiming and mode of delivery, thenperinatal mortality was reduced(nearly equivalent to that observedin normalpregnancies.)

The availability of insulin since 1922, restored fertility and virtually abolished maternal mortality. At the same time, perinatal survival did not change appreciatably. Since 1949 White Classification was developed, permitted individualized timing and mode of delivery, then perinatal mortality was reduced (nearly equivalent to that observed in normal pregnancies.)

I.classificationTypeIDiabetesMellitus.---insulin-dependent.---immune-mediatedanddevelopedin geneticallysusceptiblepersons.---concordanceratefordiabetesinmonozygoustwinsislessthan50%

I. Classification Type I Diabetes Mellitus -insulin-dependent -immune-mediated and developed in genetically susceptible persons -concordance rate for diabetes in monozygous twins is less than 50%

TypeIl diabetes-noninsulin-dependent---no HLAassociation---familialoccurrence---concordanceratefor diabetesinmonozygoustwinsis100%

Type II diabetes -noninsulin-dependent -no HLA association -familial occurrence -concordance rate for diabetes in monozygous twins is 100%

Gestational Diabetes MellitusDiabetes isthe mostcommonmedical complicationof pregnancy.Patient can beseperated into thosediagnosed during pregnancyIt is estimated that 90 percent of allpregnacies complicated by diabetesare due to gestational diabetesApproximately15percentofwomenwith gestational diabetes will exibitfastinghyperglycemia

Gestational Diabetes Mellitus Diabetes is the most common medical complication of pregnancy. Patient can be seperated into those diagnosed during pregnancy It is estimated that 90 percent of all pregnacies complicated by diabetes are due to gestational diabetes Approximately 15 percent of women with gestational diabetes will exibit fasting hyperglycemia

Classification during pregnancyTable1givesaclassificationrecommendedbytheAmericanCollegeof ObstetriciansandGynecologistsin1986

Classification during pregnancy Table 1 gives a classification recommended by the American College of Obstetricians and Gynecologists in 1986

Il.Diagnosis(U)Diagnosis of Overt Diabetes duringPregnancyi.presenceof classicalsignsandsymptoms(suchaspolydipsia,polyuria,unexplained weight loss)ii.a random plasma glucose levelgreaterthan 200mg/dlorfastingglucose>=126mg/dlili.presenceofketoacidosis

II. Diagnosis (I)Diagnosis of Overt Diabetes during Pregnancy i.presence of classical signs and symptoms (such as polydipsia, polyuria, unexplained weight loss) ii.a random plasma glucose level greater than 200mg/dl or fasting glucose>= 126mg/dl iii.presence of ketoacidosis

()Diagnosisof gestational diabetesi.High risk factors: a familial historyof diabetes,given birthto largeinfants,unexplainedfetal lossesobesityii.Screaning50g oral glucose challengetest:Avalueof140mg/dl(7.8mmol/l)orhigherwill identify80%ofall womenwith gestational diabetes

(II)Diagnosis of gestational diabetes i.High risk factors: a familial history of diabetes, given birth to large infants, unexplained fetal losses, obesity ii.Screaning 50g oral glucose challenge test: A value of 140mg/dl(7.8mmol/l)or higher will identify 80% of all women with gestational diabetes

ili.DiagnosiscriteriaIftheresultsof50goralglucosechallengetestexceed7.8mmol/l,adiagnostic75goralglucosetolerancetestis performed

iii.Diagnosis criteria If the results of 50g oral glucose challenge test exceed 7.8mmol/l, a diagnostic 75g oral glucose tolerance test is performed