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Diabetes in pregnancyDiabetes in pregnancy
Zohar Nachum, MDZohar Nachum, MDDirector ofDirector of
Maternal-Fetal Medicine UnitMaternal-Fetal Medicine UnitOb&Gyn DeptOb&Gyn Dept
Ha’Emek Med Center, AfulaHa’Emek Med Center, Afula
Case
25 yr old, 6 yr DMConsultation before pregnancyType of DM – type 1Complications – workupThyroid function testsFolic acid
Glucose controlGlucose control
Glucose ControlGlucose Control
Glucose profile, SC sensor, IV sensor
DietInsulinOral hypoglycemicsMultiple injections vs pumpInsulin analogsTight control – prevention of
complications vs hypoglycemia95 – 120 - 95
First trimesterFirst trimesterComplications – abortions, malformationsNTHypoglycemia, diabetic ketoacidosisClass – control, compliance, vasculopathy
Second trimesterSecond trimester
Targeted US – 15 w, 22 wTTLearning disabilities in school
Third trimesterThird trimester
GDM – GCT - OGTT – 105 – 190 – 165 –
145 - 95 - 180 - 155 – 140
PTD - steroidsGrowth – LGA, SGATesting – NST, BPP, Doppler, OCT
DeliveryDelivery
38 w – EFW – clinical, US - > 4000 gr – CS - PV - 3700 – 3999 – induction
Glucose control during labor and delivery
Post Partum - childPost Partum - child
Neonatal complications – RDSHypoglycemiaHyperbilirubinemiaPolycytemiaHypocalcemia, hypomagnesemia
Long term – Obesity, DM, learning disabilities
Post Partum - motherPost Partum - mother
HypoglycemiaDM – post GDM - later in lifeNext pregnancy - GDMContraception – combined OC, IUD,
progestin only
Diabetic named Ruth began to inject“The conventional way – should I reject?”“The answer is clear as a doveThe treatment is like making loveThe intestifued way gets the best effect…”
SummarySummary
Thank you Thank you