Effect of diabetes on pregnancy- on mother

Effect of diabetes on pregnancy- on mother

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  Effect of DiabetesonEffect of Diabetes on Pregnancy- on MotherPregnancy- on Mother -- R.MalarvizhiR.Malarvizhi
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  Effect of Diabeteson PregnantEffect of Diabetes on Pregnant WomenWomen  Diabetes and pregnancy interact significantlyDiabetes and pregnancy interact significantly such that maternal welfare can be seriouslysuch that maternal welfare can be seriously jeopardizedjeopardized
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  In Diabetic PregnancyInDiabetic Pregnancy  As pregnancy advancesAs pregnancy advances  Carbohydrate tolerance is reduced andCarbohydrate tolerance is reduced and  Insulin requirements usually tend to rise,Insulin requirements usually tend to rise,  Usually after 6Usually after 6thth month until shortly before termmonth until shortly before term  Renal threshold is often reducedRenal threshold is often reduced  Patient has glycosuria more than beforePatient has glycosuria more than before  which may lead to acidosis easily.which may lead to acidosis easily.  Under these circumstances, in combating acidosis withUnder these circumstances, in combating acidosis with insulin, hypoglycemia is easily provoked, especiallyinsulin, hypoglycemia is easily provoked, especially during night (difficult to stabilize)during night (difficult to stabilize)
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  During PregnancyDuring Pregnancy Abortion- more common in uncontrolledAbortion- more common in uncontrolled diabetes and fetal anomaliesdiabetes and fetal anomalies  Pre-eclampsia- increased incidence (25%)Pre-eclampsia- increased incidence (25%)  Risk factors- any vascular complications, pre-Risk factors- any vascular complications, pre- existing proteinuria and chronic hypertensionexisting proteinuria and chronic hypertension
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   Polyhydramnios(25-50%)Polyhydramnios(25-50%)  Neuraltube defects,Neural tube defects,  Large baby,Large baby,  Large placenta,Large placenta,  Fetal hyperglycemia leading to polyuria,Fetal hyperglycemia leading to polyuria,  Increased glucose concentration of liquor irritatingIncreased glucose concentration of liquor irritating the amniotic epithelium or increased osmosisthe amniotic epithelium or increased osmosis  Preterm labour- (20%)- due to infection orPreterm labour- (20%)- due to infection or polyhydramniospolyhydramnios
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   Infection- morecommon, especially UTIInfection- more common, especially UTI  80% IDD women have at least 1 episode of80% IDD women have at least 1 episode of infection compared to 25% in non-diabeticinfection compared to 25% in non-diabetic pregnant womenpregnant women  Besides UTI ,Besides UTI , CandidaCandida vulvovaginitis andvulvovaginitis and respiratory tract infections also commonrespiratory tract infections also common  Antepartum pyelonephritis is increased 4x inAntepartum pyelonephritis is increased 4x in women with diabetes and can be minimized bywomen with diabetes and can be minimized by screening for asymptomatic bacteriuriascreening for asymptomatic bacteriuria
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   Maternal distress-due to combined effect ofMaternal distress- due to combined effect of oversized fetus and polyhydramniosoversized fetus and polyhydramnios
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   Diabetic retinopathyDiabeticretinopathy  Related to duration of diabetes and with glycemic controlRelated to duration of diabetes and with glycemic control  Early visible lesions.-Benign or background non-Early visible lesions.-Benign or background non- proliferative retinopathy. Seen in class D (regardless ofproliferative retinopathy. Seen in class D (regardless of duration)duration)  With severity -Pre-proliferative retinopathyWith severity -Pre-proliferative retinopathy  Neovascularisation and subsequent haemorrhage on retinalNeovascularisation and subsequent haemorrhage on retinal surface and in the vitreous cavity obscure visionsurface and in the vitreous cavity obscure vision  LASER photocoagulation before these vessels haemorrhageLASER photocoagulation before these vessels haemorrhage reduces progression to visual loss and blindness and is indicatedreduces progression to visual loss and blindness and is indicated during pregnacy for affected womenduring pregnacy for affected women
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  NPDR PDR ME
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   Diabetic nephropathyDiabeticnephropathy  Incidence 5%Incidence 5%  Half of them develop pre-eclampsiaHalf of them develop pre-eclampsia  Chronic hypertension with diabetic nephropathy increasesChronic hypertension with diabetic nephropathy increases the risk of preeclampsia to 60%the risk of preeclampsia to 60%  Before 20 weeksBefore 20 weeks  Plasma creatinine – 1.5mg/dL or greater,Plasma creatinine – 1.5mg/dL or greater,  Protein excretion of 3g per 24 hrs or greater,Protein excretion of 3g per 24 hrs or greater, is predictive of pre-eclampsiais predictive of pre-eclampsia  Pregnancy does not exacerbate or modify diabeticPregnancy does not exacerbate or modify diabetic nephropathynephropathy
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   KetoacidosisKetoacidosis  Only1% of diabetic pregnancy though MaternalOnly 1% of diabetic pregnancy though Maternal fluid and electrolyte balance is easily distruptedfluid and electrolyte balance is easily distrupted during pregnancyduring pregnancy  One of the most serious complicationsOne of the most serious complications  Prominent factor implicated as cause in recurrenceProminent factor implicated as cause in recurrence is – non-complianceis – non-compliance  Fetal loss 20 %Fetal loss 20 %
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   Diabetic CardiomyopathyDiabeticCardiomyopathy  Increased risk of CAD, and a high risk of maternal death in post MI patients (50%)  CardiomyopathyCardiomyopathy
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  During LabourDuring Labour Increased incidence ofIncreased incidence of  Prolongation of labour- due to big babyProlongation of labour- due to big baby  Shoulder dystocia- due to disproportionate growthShoulder dystocia- due to disproportionate growth with increased shoulder/head ratiowith increased shoulder/head ratio  Operative interferenceOperative interference  Perineal injuriesPerineal injuries  Postpartum haemorrhagePostpartum haemorrhage ( above are mainly due to big baby)( above are mainly due to big baby)
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  During PueperiumDuring Pueperium Pueperal sepsisPueperal sepsis  Due to prolonged labour and increased incidenceDue to prolonged labour and increased incidence of intervention methodsof intervention methods  Increased incidence of chorioamnionitis and postIncreased incidence of chorioamnionitis and post partum endometritis.partum endometritis.  Lactation failureLactation failure  Large baby- hypoglycemia, prematurity andLarge baby- hypoglycemia, prematurity and lethargy---lead to poor sucklinglethargy---lead to poor suckling
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   ReferenceReference  Textbookof Obstetrics-D.C.DuttaTextbook of Obstetrics-D.C.Dutta  Benson and Pernoll’s Handbook of Obstetrics andBenson and Pernoll’s Handbook of Obstetrics and GynaecologyGynaecology  Williams and Wilkins Handbook of ObstetricsWilliams and Wilkins Handbook of Obstetrics  Ian McDonald Manual of ObstetricsIan McDonald Manual of Obstetrics
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