DIABETES AND PREGNANCY: A 13

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DIABETES AND PREGNANCY A 13YEAR STUDY.

• Jessica Bardales Mitac, M.D
• John Essien, M.D
• HOSPITAL GINECOBSTÉTRICO DOCENTE PROVINCIAL,
  CAMAGÜEY, CUBA

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A Brief History
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Origin
Genetic
Intervene in lesser or greater degree

• Environmental Factors

• Immunological Factors

• Viral Infections

Extrinsic Factors
Hereditary Factors

• Identical twin
• Both parents diabetic
• One of the parents diabetic and the non diabetic
  parent with a relative of the 1st order diabetic
  or a brother with a diabetic child.

• Obesity
• Stress
• Pregnancy
• Infections
• Trauma

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PREGNANCY A DIABETOGENIC EVENT
The woman is transformed from a physiological
point of view by

• Nutritional demands by the fetus
• Metabolic changes in the mother
• Placenta as a site of exchange and its hormonal
  effects
• Insulin -Progesterone
• Glucagon -Estrogen
• Somatotropic Hormone
• Cortisol
• Adrenalin
• Thiroxin
• Placental lactogen

Langerhans Islets
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COMPLICATIONS DURING GESTATION
Infections Urinary Vaginal
Preterm labor
Hidramnios
Toxemia
Acidosis
Vascular Retina Renal
Coma
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A BALANCED DIET A FUNDAMENTAL PILLAR

• OBJETIVES
• Reach and maintain a normal nutritional status.
• Obtain growth and development according to the
  gestational age.
• Achieve an adecuate psycological and physical
  capability.
• Obtain normal blood sugar levels all day
• Achieve normal levels of the diverse lipid
  fractions in serum.
• Absence of macroangiopathic complications.
• Avoid the development of microangiopathies and
  neuropathies.
• Maintain adecuate immunologic capacity against
  infections.

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REPERCUSIONS ON
Fetus
Embryo
Newborn
Abortions
Malformations
Growth alterations MACROSOMIA IUGR
Alterations of maturity Respiratory distress
syndrome
Metabolic alterations Hypoglicemia Hyocalemia Hype
rbilirubinemia Policitemia
Distocia
Perinatal asphyxia
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Results
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Conclusions
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• The mean age of the women studied was 27,35,4
  years.
• 678 women of the universe of study had
  gestational diabetes y 207 were known diabetics.
• 80 patients were evaluated as havingpoor
  maternal-fetal prognosis, 10 were of poor
  maternal prognosis and all were insulin-dependent
  diabetics.
• Malnutrition was presented by the majority of
  the gravidae.

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• The control of Diabetes was achieved using
  dietary measures in nearly half of the universe.
• Distocic delivery was perforned in 432
  parturients, of which 201 underwent primitive
  cesarean section.
• The mean weight of the newborn was 3145686
  grams.
• Low Apgar Score at the fifth minute of life was
  presented by 8 neonates.