Diabetes in Pregnancy

1
Diabetes in Pregnancy

• Effects on the fetus

2
Macrosomia

• Maternal hyperglycaemia leads to induction of
  hyperinsulinemia in the fetus (to keep BSLs
  normal).
• Insulin has a role as a
• growth factor, which is potentiated
• in pregnancy, leading to
• acceleratedanabolism, or growth.
• The result large, disproportionate infant gt4.5kg
  (compared to average of 3.4kg)
• In turn, the large size of these babies means
  that it is more likely that they will experience
  birth trauma (shoulder dysostocia, etc)

3
Congenital Anomalies

• CVS ventricular septal defects
• Neuro neural tube defects
• Genitourinary cystic kidneys
• GIT anal atresia
• Musculoskeletal sacral agenesis.
• PLEASE NOTE these conditions are only more
  common in the fetuses of mothers with
  pre-existing diabetes, not in those whose mothers
  develop gestational diabetes.

4
Other effects

• Delayed fetal lung maturity
• decreased and later surfactant synthesis due to
  hyperglycemia
• IUGR
• Polycythemia
• HT, cardiac hypertrophy.
• Perinatal hypoglycaemia, hypocalcemia,
  hypomagnesia and/or hypobilirubinemia

5
Survival Disadvantage

• Increased incidence of spontaneous abortion (T1).
• Increased incidence of pre-term labour (T2-3)
• Higher rates of prematurity
• Higher incidence of stillbirths.

6
References

• http//www.utdol.com/online/content/topic.do?topic
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• http//www.123rf.com/stock-photo/baby.html