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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.
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