Description #
This is an Obstetrics and Gynecology unit.
Learning Objectives #
The Students should be able to:
– Explain the interaction between pregnancy and many medical and surgical conditions
– Illustrate the principles of management of pregnancies complicated by medical diseases
– Present an overview of some important medical diseases
– Review the role of maternal physiologic changes on diagnosis and management in pregnancy
Classification of Diabetes Mellitus #
Classification of Diabetes Mellitus:
Type I : refers to diabetes diagnosed in childhood.
Type II :
Type III or Gestational diabetes
In either case, diabetes has significant implications for mother and fetus during pregnancy.
It is thought to be caused by immunologic destruction of cells of the pancreas, resulting in necessary insulin replacement. Diabetic ketoacidosis (DKA) is more common in patients with this type of diabetes.
Type 2 diabetes mellitus
is adult-onset glucose intoler-ance. Patients with type 2 diabetes mellitus are frequently overweight, and the disease can often be controlled with
weight control and a carefully followed diet. This type ofdiabetes is thought to result from insulin resistance andexhaustion of the cells, rather than their destruction.•
Gestational diabetes mellitus (GDM)
refers to glu-cose intolerance identified during pregnancy. In mostpatients, it subsides postpartum, although glucose intol-erance in subsequent years occurs more frequently inthis group of patients.
Physiology of Glucose Metabolism in Pregnancy
Dietary habits frequently change during pregnancy. Foodintake may decrease early in pregnancy because of nauseaand vomiting, and food preferences may change later inpregnancy. Several pregnancy-associated hormones alsohave a major effect on glucose metabolism. Most notableof these is
human placental lactogen (hPL),
which isproduced in abundance by the enlarging placenta. HPLaffects both fatty acid and glucose metabolism. It promoteslipolysis with increased levels of circulating free fatty acidsand causes a decrease in glucose uptake. In this manner,hPL can be thought of as an anti-insulin. The increasingproduction of this hormone as pregnancy advances gener-ally requires ongoing changes in insulin therapy to adjustfor this effect.Other hormones that have demonstrated lesser effectsinclude estrogen and progesterone, which interfere withthe insulin-glucose relation; and nsulinase, which is pro-ducedby the placenta and degrades insulin to a limitedextent. These effects of pregnancy on glucose metabolismmake the management of pregnancy-associated diabetesdifficult. DKA, for example, is more common in pregnantpatients.With increased renal blood flow, the simple diffusionof glucose in the glomerulus increases beyond the ability oftubular reabsorption, resulting in thenormal glucosuriaof pregnancy, commonly of approximately 300 mg/day.In patients with diabetes, this glucosuria may be muchgreater, but because of the poor correlation of pregnancyglucosuria values and simultaneous blood glucose concen-trations, using urinary glucose levels is of little value inglucose management during pregnancy. Fetal Morbidity and Mortality in Presestation: