Diabetic disease in pregnancy& it’s complication

Definition: is defined as carbohydrate disturbance characterized by hyperglycemia & either peripheral insulin resistance or insulin deficiency.

There are 2 types of D.M : 1.IDDM(type 1)
2.NIDDM( type 2)


Where there my be a serological evidence of autoimmune destruction of pancreatic islets & genetic marker in type 1 DM, type 2 may be hyperglycemia for long period without clinical symptoms( familial).
The symptoms of D.M is closely related to the degree of hyperglycemia& these include polyurea, polydepsia, weight loss, recurrent vulvar boils& bleured vision.

Incidence:

It complicate 1-2% of pregnancy with high PNM& mortality reach about 65% but after introduction of insulin ,this percentage fall as in non diabetic mother in a well controlled D.M.


Pathophysiology:
During pregnancy ,there is significant change in carbohydrate metabolism& glucose homeostasis secondary to complex hormonal changes like estrogen ,progesterone ,human placental lactogen& cortisol. HPL lead to increase lipolysis in the adipose tissue, this result in the production of glycerol & fatty acid which are used as a source of energy by the mother & this lead that glucose up take in the cell is inhibited ,so a lot of glucose is available to the fetus.

The placenta not only produce diabetogenic hormones but also break down insulin.
Reduced threshold for glucose & increase GFR result in glucoseuria in about 5-50% of women