Diabetes and Pregnancy: A 13–year Study.

8/14/2019 Diabetes and Pregnancy: A 13year Study.

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DIABETES AND

PREGNANCY: A 13YEARSTUDY.

Jessica Bardales Mitac, M.DJohn Essien, M.D

HOSPITAL GINECOBSTTRICO DOCENTE PROVINCIAL,CAMAGEY, CUBA


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Thomas Willis(1766)

1696

Areteo of Capodocia(II b.c)

Celso( I b.c)

Other ancient cultures

Ancient China

Eberts Papyrus

A BriefHistory

Presence of sugar(Mellitus=Sugar)

Evidence of Inheritance

Diabetes(unquenchablethirst)

Polyuria, Polydipsia

Excessive hunger

Thirst disease

Frequent and abundantelimination of urine.sweeturine


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Insulin MoleculeSanger(1960)

Pancreatic extractBonting & Best(Canada)

IsletsLangerhans(Berlin, 1869)


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10th cause of mortalityIn Cuba

Today

Mortality rate 50%Survival rate 40%

Beginning of XXCentury


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GeneticOrigin

Intervene in

lesser orgreater degree

Environmental Factors

Immunological FactorsViral Infections

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.

Extrinsic Factors

Obesity Stress Pregnancy Infections Trauma


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PREGNANCY: A DIABETOGENIC EVENT

Langerhans Islets

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 andits hormonal effects:

-Insulin -Progesterone

-Glucagon -Estrogen-Somatotropic Hormone-Cortisol-Adrenalin-Thiroxin

-Placental lactogen


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COMPLICATIONS

DURING

GESTATION

Toxemia Preterm

labor

Infections

Urinary

Vaginal

Vascular

RetinaRenal

Acidosis

Coma

Hidramnios


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A BALANCED DIET: A FUNDAMENTAL

PILLAROBJETIVES

Reach and maintain a normal nutritional status. Obtain growth and development according to the

gestational age.

Achieve an adecuate psycological and physicalcapability. 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:

EmbryoFetus

Newborn

AbortionsMalformations

Growth

alterationsMACROSOMIA

IUGR

Distocia

Perinatal asphyxia

Metabolic alterations

HypoglicemiaHyocalemia

HyperbilirubinemiaPolicitemia

Alterations of

maturity

Respiratory distress

syndrome


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Results


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TABLE 1.

Age and Parity.

PARITYAGE0 1 2 AND ABOVE TOTAL

15 AND LESS 6 6

16-2058 16 4 78

21-25 154 62 25 241

26-30 48 139 58 245

>30 88 151 151 390

TOTAL 354 368 238 960

SOURCE: FORM


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TABLE 2.

World Health Organization Classification and Prognosis.

PROGNOSISW.H.O. CLASSIFICATION.

GMFP PMFP PMP TOTAL

Insulin Dependente 79 80 10 169

Insulin Independent 38 38

Gestational Diabetes 678 678

AGT Potential 39 39

AGT Praevia 36 36

TOTAL 870 80 10 960

SOURCE: Form P 0.05

LEGEND: GMFP- GOOD MATERNAL-FETAL PROGNOSIS

PMFP- POOR MATERNAL FETAL PROGNOSIS

PMP- POOR MATERNAL PROGNOSIS


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TABLE 3.

Nutritional Status and Weight gain.

NUTRITIONAL STATUSWEIGHTGAIN(Kg.) Normal

weightLow weight Over

weightTOTAL

2 and less 17 17 34

4-630 2 148 180

7-9 47 12 115 174

10-12 187 38 34 259

13-15 120 74 31 225

16and over 35 23 30 88

TOTAL 436 149 375 960SOURCE: FORM P 0.05


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TABLE 4.

Treatment Administered

TREATMENT NUMBER PERCENTAGE

DIET 451 46.91

15-30 U 422 43.95

31-45 U 22 2.3

46-60 U 16 1.7

61-75 U 7 0.7

76-90 U 11 1.2

91-115 U 21 2.2

>115 U 10 1.04

TOTAL 960 100.00

SOURCE: FORM P 0.05


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TABLE 5.

Type of delivery and weight of the newborn

WEIGHT OF THE NEWBORN (GRAMS)

TYPE OF

DELIVERY

2499 AND

LESS

2500-

2999

3000-

3499

3500-

3999

4000 AND

MORE TOTAL

Normal 23 84 311 95 25 538

Instrumentation 25 24 25 74

Primitive Cesarean 18 25 59 21 78 201

Reiterated Cesarean 27 31 27 33 29 147

TOTAL 68 165 397 173 157 960

SOURCE: FORM P 0.05


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TABLE 6.

Relation of Apgar Score at first and fifth minutes.

APGAR AT FIFTH MINUTE

APGAR

AT FIRST

MINUTE4-6 7-10 TOTAL

0-3 2 8 10

4-6 6 39 45

7-10 891 891

TOTAL 8 938 946

SOURCE: FORM P 0.05


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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 poormaternal prognosis and all were insulin-dependent diabetics.

Malnutrition was presented by the majorityof the gravidae.


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The control of Diabetes was achieved

using dietary measures in nearly half of theuniverse.

Distocic delivery was perforned in 432

parturients, of which 201 underwentprimitive 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.

Diabetes and Pregnancy: A 13–year Study.

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