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Dr Ellen TothDr Ellen Toth
University of Alberta University of Alberta
Diabetes Specialist Diabetes Specialist
Diabetes Complicating pregnancies
Presentation to Maskwacis– November 2012
Diabetes Complicating pregnancies
Presentation to Maskwacis– November 2012
Pregnancy, Maskwacis, 2012
The epidemicPopulation growth Case finding
Behaviours
Environment
Diabetes
GeneticsModified from Engelgau
Pregnancy: Diabetes begets diabetes
Plan for this talk
Introduction
How does diabetes complicate pregancy?
What can be done? (Standing Strong)
Pregnancy, Maskwacis, 2012
Plan for this talk
Introduction
How does diabetes complicate pregancy?
What can be done? (Standing Strong)
Pregnancy, Maskwacis, 2012
Pregnancy and Diabetes
Pre-existing diabetes OR gestational diabetes both can have (epigenetic) consequences
The baby gets the increased glucose (and other good or bad nutrition) from the mother
This affects the baby’s pancreas: with lifelong consequences
Pregnancy, Maskwacis, 2012
Developmental trajectory
Sensitive
phase
Genetic devlopment Environmental
influences: nutrition etc
Epigenetic adaptation: modification of genes resulting in different phenotypes
Pregnancy, Maskwacis, 2012
The Barker Hypothesis
Also shown for cancer, diabetes, chronic lung disease
Pregnancy, Maskwacis, 2012
Prevalence of Gestational Diabetes: A: Pimas, B: Norway, C: African Americans, D: New York State
Pregnancy, Maskwacis, 2012
Consequences of poorly, uncontrolled or undiagnosed diabetes in pregnancy
Early miscarriages
Large babies (and birth complications)
Congenital defects: heart, spine, cleft palate, “prune belly”, hydrocephalus
Still births
Childhood obesity
DiabetesPregnancy, Maskwacis, 2012
Definitions
Pre-existing diabetes: Type 1 or Type 2 before conception
Type 2 can (often) be undiagnosed
Gestational diabetes: Type 1 or Type 2 first “recognised” during pregnancy
Either undiagnosed Type 2 (Overt)
Or predictor of Type 2
Very rarely Type 1
Pregnancy, Maskwacis, 2012
Definitions
Diabetes before pregnancy
Diabetes in early pregnancy
Diabetes in late pregnancy
Pregnancy, Maskwacis, 2012
What to do?
Know whether you have diabetes or not
Plan your pregnancy
Screening
Before pregnancy
In early pregnancy
(Universal screening recommended at 24- 28 weeks EXCEPT if increased risk factors)
Pregnancy, Maskwacis, 2012
Gestational Diabetes---Risk Factors
Overweight
Family history of diabetes
Over 25 years old
Previously delivered a large baby
Being of non-white heritage (ethnic groups)
Pregnant with more than one baby
Pregnancy, Maskwacis, 2012
Gestational Diabetes---Risk Factors
Overweight
Family history of diabetes
Over 25 years old
Previously delivered a large baby
Being of non-white heritage (ethnic groups)
Pregnant with more than one baby
Pregnancy, Maskwacis, 2012
Gestational Diabetes
Diabetes during pregnancy.
Causes: Hormones that help the baby develop can affect your own insulin's ability to handle sugar. This is a type of insulin resistance.
Both mother and child are at a higher risk of developing type 2 diabetes later in life.
Pregnancy, Maskwacis, 2012