DIABETES

A   32-year-old Hispanic    multigravida    is  at  29  weeks’  gestation.  Her 1-h 50-g

glucose screen  came    back    at  175 mg/dL.  She is  60  inches  tall    and weighs

200 pounds. Her pregnancy   weight  gain    has been    30  pounds  thus    far.    Her

previous    babies  weighed 3,800   and 4,200   g.

If a pregnant woman is unable to maintain fasting (FBS) or postchallenge
glucose values in the normal pregnant range before or after a standard 100-g
glucose challenge, she is considered to have diabetes.

The most common risk factors for gestational diabetes are obesity, age >30, and
positive family history. Other risk factors are fetal macrosomia, unexplained
stillbirth or neonatal death, polyhydramnios, and previous traumatic delivery.

Prevalence of glucose intolerance in pregnancy is 2–3%.

Classification is done as follows.

Gestational diabetes    mellitus    (GDM)   (most   common  type    with    onset   during

pregnancy)  is  usually diagnosed   in  the last    half.   Pathophysiology involves    the

diabetogenic    effect  of  human   placental   lactogen    (hPL),  placental   insulinase,

cortisol,   and progesterone.   Within  5–10    years   after   delivery,   35% of  women

with    GDM will    develop overt   diabetes.

Type    1   DM  is  juvenile    onset,  ketosis prone,  insulin-dependent   diabetes

caused  by  pancreatic  islet   cell    deficiency.

Type    2   DM  is  adult   onset,  ketosis resistant,  non–insulin-dependent   diabetes