Posts Tagged ‘Pregnancy Problem in the Diabetic Women’
The problems of pregnancy in the diabetic may be considered under several headings:
Mental Problems
• Hypoglycemia – Hypoglycemia is common in the first half of pregnancy, especially in the first quarter. Fortunately, the fetus tolerates well hypoglycemia.
• Retinopathy (retinal damage)
Retinopathy is already present in many women at the beginning of pregnancy, and can progress in line is advanced. Regular ophthalmoscopy is therefore important. Paradoxically, the progression of retinopathy may be related to the initiation of a strict metabolic control. When neovascularization, photocoagulation can be controlled, and is not therefore an indication for termination of pregnancy.
* Nephropathy (kidney damage)
Diabetic nephropathy in pregnancy is defined as the presence during the first half of pregnancy proteinuria (presence of protein in the urine) is persistent, more than 400 mg in 24 hours, in the absence of infection.
Many patients also have high blood pressure and other complications resulting from kidney damage. These cases require careful monitoring and control of hypertension and diabetes mellitus, with early hospitalization and inducing labor.
Patients with functioning kidney transplants often have successful pregnancies.
FETAL PROBLEMS
* Malformations
Congenital malformations occur in 6-8% of children of diabetic mothers: they are three times more frequent than in the general population. The rate of malformations covers a broad spectrum, but the defects of the neural canal and cardiac injuries are quite common.
Therefore, you should advise the diabetic women to plan their pregnancy and with prior notice, in order to achieve the best possible control before conception takes place. Compliance with this advice may reduce the number of malformations
* Macrosomia (large size newborn)
* Neonates small for gestational age
Although normal in offspring of diabetic mothers is macrosomia, some babies are small for gestational age, due to intrauterine growth retardation. This is more common in diabetic patients with long evolution of vascular complications.
MORTALITY IN NEWBORN
* Respiratory distress syndrome (RDS) or hyaline membrane disease
When patients routinely pariahs at 36-37 weeks gestation due to lack of maturation of the lungs of the newborn, respiratory disturbance occurred many times it was deadly. Today this problem can be expected to time to avoid many deaths from this cause.
* Hypoglycemia -Neonatal hypoglycaemia is common, especially in children macrosomic. Strict metabolic control of the mother and newborn after birth reduces the frequency and severity of neonatal hypoglycaemia.