上海交通大学医学院：《妇产科学》（双语） 11 Medical Complication pRegnancy

Medical complication InPregnancy Diabetes

Medical Complication In Pregnancy Diabetes

e 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

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

e 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

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.)

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

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%

● Type ll diabetes noninsulin-dependent no hla association --familial occurrence concordance rate for diabetes in monozygous twins is 100%

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

e Gestational Diabetes Mellitus e 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 e Approximately 15 percent of women with gestational diabetes will exibit fasting hy perglycemia

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

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

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

class onset Fasting plasma 2-hour therapy glucose postprandial glucose A1 Gestational105mg/dI 120mgld Insulin Class Age of Duration(yr) / ascular disease Therapy onset(yr) B >20 10 None Insulin 10-19 10-19 None Insulin D 10 >20 Benign Insulin retinopathy F Any Any nephropathy Insulin R Any Any Proliferative Insulin tinopathy H An y An y Heart Insulin Any Any Transplantation Insulin of kianey

class onset Fasting plasma glucose 2-hour postprandial glucose therapy A1 Gestational 105mg/dl >120mg/dl Insulin Class Age of onset(yr) Duration(yr) Vascular disease Therapy B >20 20 Benign retinopathy Insulin F Any Any nephropathy Insulin R Any Any Proliferative retinopathy Insulin H Any Any Heart Insulin T Any Any Transplantation of kianey Insulin

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

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

.(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 140mgdi(7.8mmol/or higher will identify 80% of all women with 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