Diabetes Mellitus As A Disease Affecting Pregnancy

DIABETES MELLITUS AS A DISEASE
AFFECTING PREGNANCY
DIABETES MELLITUS
• A chronic, hereditary, metabolic disorder characterized by deficeincy in insulin
production by the islets of langerhans resulting abnormalities in protein, fats, and
carbohydrates metabolism ( breakdown/ absorption).
• Endocrine disorders in which the pancreas is unable to produce adeqaute insulin to
regulate body glucose derived from bread, potatoes, and other carbohydrate-rich
foods)
• Approx 2% to 3% of all women who do not begin a pregnancy with diabetes
become diabetic during pregnancy, usually at the midpoint of pregnancy when
insulin resistance becomes most noticeable.
• This is termed GESTATIONAL DIABETES.
What causes GDM
• The placenta supplies a growing fetus with nutrients and water
• The placenta also produces a variety of hormones to maintain the
pregnancy.
• Some of these hormones (estrogen, cortisol, and human placental
lactogen) can have a blocking effect on insulin.
• This is called contra-insulin effect, which usually begins about 20 to 24
weeks into the pregnancy.
Islet of Langerhans
DIABETES MELLITUS
• The symptoms will fade again at the completion of pregnancy,

but the woman with gestational diabetes may have as high a
risk of 50% of developing diabetes later in life.
• INCIDENCE: 1% - 5% of woman during pregnancy, may be
concurrent disease in pregnancy or have its first onset on
pregnancy
Predisposing Factors of DM
a. Family History of DM
b. Rapid hormonal changes in pregnancy (estrogen, cortisol, and human placental
lactogen) can have a blocking effect on insulin)
c. Tumor/infection of the pancreas
d. Obesity- in an obese individual, the amount of glycerol, hormones,
cytokines, proinflammatory substances, and other substances that are involved in
the development of insulin resistance are increased.
-Insulin resistance with impairment of β-cell function leads to the
development of diabetes.
Effects of Diabetes Mellitus to the Mother
a. Infertility -diabetic condition prevents the embryo from implanting in the uterus causing
recurring miscarriages
b. Spontaneous abortion- because of vascular complications w/c affect placental circulations
c. PIH- extra sugar builds up on the blood causing hypertension
d. Utero-placental insufficiency due to alteration of placental development and subsequent
vascular dysfunction
e. Dystocia- due to excessively large baby
f. Premature Labor due to vascular dysfunction
g. Infections: UTI; moniliasis because of protein as a result of diabetic nephropathy ( kidney
disease)
h. Hyperglycemia ( high blood glucose)
i. Cesarian delivery often indicated because of large baby
Effects of Diabetes Mellitus to the Fetus/Baby
a. Polyhydramnios -When a pregnant woman's blood sugar levels are not well controlled, the
baby's urine output increases, leading, potentially, to excessive amounts of amniotic fluid.
b. Fetal hypoxia (IUFD)-Chronic intrauterine hypoxia caused by maternal diabetes is the most
likely cause of stillbirths during the last weeks of pregnancy.
Both fetal hyperglycemia and hyperinsulinemia can independently cause fetal chronic hypoxia
by increasing fetal oxygen consumption
c. Macrosomia
d. Stillbirths
e. Neonatal prematurity & RDS
f. Neonatal hypoglycemia as a response to maternal hyperglycemia
Effects of Pregnancy on DM
a. DM is more difficult to control
b. Blood sugar is less easily controlled
c. Insulin shock is common
Assessment of DM
A. History
▪ Familial
▪ Previous infant weighing 4000g or more with
congenital defects
▪ Hx of polyhydramnios
B. Abdominal Assessment
• Bigger than date fundus
• polyhydramnios
Symptoms of Hyperglycemia in a Diabetic Pregnant
• Polyuria- excessive urination -, excess sugar ends up in the urine, where it pulls
more water and results in more urine.
• Polyphagia- also known as hyperphagia, is an intense hunger that is not satiated
by eating.
-The craving can be for food in general, or a specific food, and
leads to overeating.
• Polydipsia- a medical name for the feeling of extreme thirstiness
- is often linked to urinary conditions that cause a pregnant to
urinate a lot
• Weight loss
• Increased sugar in urine & blood
Assessment of DM
D. Diagnosis
⮚ Made on the basis of the GTT
⮚ Procedure
a. NPO after midnight
b. 2mL of 50% glucose /3kg of pre-pregnant body weight is given IV (oral tablet not advisable
because of known decreased gastric motility & delayed absorption of sugar during pregnancy)
c. Interpretation of results:
▪ If less than 100mg%-------normal
▪ If 100-120mg%--------------possible gestational diabetes
▪ If more than 120mg%------overt gestational diabetes
Normal Metabolic Changes In Pregnancy That Affects Pregnant
Woman with DM
1. Increase hormone production by placenta(HPL, estrogen, progesterone)-
decreased insulin effectiveness
2. Increased activity of the APG= decreased tolerance for sugar
3. Normal lowered renal threshold for glucose = glucosuria that might confuse
diabetic picture
4. Increased size of islets of langerhans to meet increased needs of the mother=
increased insulin production but insulin produced is rendered inactive or
antagonized by maternal hormones particularly HPL.
Normal Metabolic Changes In Pregnancy That
Affects Pregnant Woman with DM
5. Muscular activity in labor depletes maternal glucose store= requires increased CHO
intake
6. Hypoglycemia is common in puerperium as involution & lactation occur
Management of DM
1. Participate in early detection
2. Encourage early, frequent medical & prenatal
management & supervision – every 2 weeks visit until
the 30th week, then weekly.
3. Teach S/S of hyperglycemia (acidosis)
Management of DM
4. Help control DM
a. Diet- conerstone of management
⮚ calories = 1800-2000 daily
⮚ Protein = 70g
⮚ Carbohydrates = 200mg/day
⮚ Taken regularly
b. Exercise :help control blood sugar level
Management of DM
5. Provide Health teachings
▪ Adherence to dietary regimen
▪ Prevention of infection
▪ Aviodance of stress
▪ Need for frequent monitoring of fetal health
▪ Ultrasound
▪ Amniocentesis- amniotic fluid is removed from the uterus
▪ – for L/S ratio to determine lung maturity
▪ L/S ratio 2:1 = mature lungs – attained at 36 weeks of gestation
▪ Need for more frequent prenatal visit

Management of DM
6. Prepare for early hospitalization for possible early labor induction or CS
7. Provide post-partum care
a. Be alert for complications in the post-partum
• Hemmorhage
• Infection
• Insulin shock
• PIH
b. Encourage breastfeeding
c. Maximun difficulty in controlling DM is in the early postpartum period
• Need for suveillance

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DIABETES MELLITUS AS A DISEASE

• The symptoms will fade again at the completion of pregnancy,

▪ Need for more frequent prenatal visit

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