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DIABETES
in pregnancy (Pregnancy planning (Education
Appropriately…
DIABETES
in pregnancy
- a chronic metabolic disorder manifesting with hyperglycemia, resulting from relative or absolute insulin deficiency
- Gestational Diabetes Mellitus (GDM):Impaired glucose tolerance
manifesting for the first time or being diagnosed during pregnancy
- the most common metabolic disorder in pregnancy
Classification
- Diabetes in pregnancy
– fasting glucose ≥126 mg/dl (7.0 mmol/l)
– glucose 2h after OGTT ≥200 mg/dl (11.1 mmol/l)
– sporadic glycemia ≥200 mg/dl and clinical signs of hyperglycemia
- Gestational diabetes mellitus (GDM)
according to the respective diagnostic criteria
- Pregestational diabetes mellitus (PGDM)
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WHO classification of DM
type 1 DM – absolute insulin deficiency
type 2 DM – relative insulin deficiency
Other specific types of DM (genetic defects, endocrinopathies, drug-induced DM, infections, chemical-induced DM)
GESTATIONAL DM
Pregnancy planning
- Education
- Appropriately balanced diet
- Supplementation with folic acid in prophylactic dose
- Assessment of diabetic complications severity:
Kidney status (proteinuria, creatinine clearance)
Blood pressure (discontinuation of convertase inhibitors due to their teratogenic effect)
Cardiovascular status (ECG, ECHO, exercise test)
Status of the eye(simple and proliferative retinopathy)
- Diagnostic hospitalization
- Follow-up visits
- Achieving normoglycemia before conception (HbA1c <6.0%)
- Optimal conception timing
- Insulin therapy in women with pregestational type 2 DM
- OGTT in women with a history of GDM
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Intensive surveillance
- Monitoring of fetal movements by a pregnant woman
- Ultrasonographic assessment of fetal growth
- Fetal ECHO
- Non-stress test (NST)
- Oxytocin challenge test (OCT)
- Doppler assessment of blood flow
- Biophysical fetal profile
- Stimulation of fetal lung maturation
- Intensive care and treatment of neonates
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Criteria for compensation of diabetes
in pregnancy, self-control
- Fasting glycemia 60-90 mg/dl
- Glycemia 1h after meal < 140 mg/dl (since 2017)
- Glycemia 2-4 h after meal > 60 mg/dl
- HbA1c < 6.0 %
- Absence of acetonuria
- Absence of hypoglycemia
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