Diabetes mellitus in pregnancy

Rejekine. Diabetes Mellitus is defined as impaired glucose tolerance are known to varying degrees the first time during pregnancy regardless of whether the patient needs to receive insulin or not. In the first trimester of pregnancy (3 months) glucose levels will fall by between 55-65% and this is a response to the glucose transport from mother to fetus. DMG largely asymptomatic, so the diagnosis is determined by chance during a routine examination.


In pregnant women, to this day it is best to check with the glucose challenge test with a load of 50 grams of glucose and glycated blood levels were measured 1 hour later. If blood glucose levels after 1 hour of loading exceeds 140 mg%, then proceed with the examination of the oral glucose test tolesansi.


Patofiologi Diabetes Mellitus In Pregnancy

At DMG, in addition to these physiological changes, there will be a state in which the number / function of insulin to be not optimal. Change the kinetics of insulin and resistance to insulin effects. As a result, the composition of energy sources in maternal plasma increased (high blood sugar levels, insulin levels remain high).

Facilitated diffusion through the membrane of the placenta, where fetal circulation also occur abnormal composition of energy sources. (Causing the possibility of various complications). In addition there are also so that fetal hyperinsulinemia also experience metabolic disturbances (hypoglycemia, hipomagnesemia, hypocalcemia, hyperbilirubinemia, and so on.


Management of Diabetes Mellitus in Pregnancy

Medical management

In accordance with the medical management of diabetes mellitus in general, management is also primarily based DMG for the management of nutrition / diet and weight control mothers.

1. Strict control of blood sugar, because if birth control is less well try it early, consider fetal lung maturity. Memdadak fetal death can occur. Provide fast-acting insulin, if possible given through drips.

2. Avoid a urinary tract infection or other infections. Perform prevention of infection with both.

3. In the newborn hypoglycemia can occur quickly so it needs to be given intravenous glucose.

4. DMG is handling that particular diet, it is recommended given 25 calories / kg ideal, except in patients with the fat calories are more easily considered.

5. The recommended way is the way of Broca's BB ideal = (TB-100) -10% BB.

6. Caloric needs are taken into account the total number of calories from:

- Basal Calories 25 cal / kg ideal

- Calories physical activity by 10-30%

- 300 calories for pregnancy heat

- Keep in mind the needs of pregnant women 1-1.5 g protein / kg

If a therapeutic diet for 2 weeks of blood glucose levels have not reached normal or normoglycaemia, ie fasting blood glucose levels below 105 mg / dl and 2 hours pp below 120 mg / dl, then insulin therapy should be started immediately.

Monitoring can be done by using capillary blood glucose meter. Calculation of a balanced diet together with the calculation in the case of DM generally, with the added number of 300-500 calories per day for fetal growth during pregnancy to lactation is completed.

Management of DM in pregnancy aims to:

- Maintain a fasting blood glucose <105 mg / dl - Maintaining blood glucose levels 2 hours pp <120 mg / dl - Maintaining glikosilat Hb (Hb ALC) <6% - Preventing episodes of hypoglycemia - Prevent ketonuria / ketoacidosis deiabetik - Ensuring optimal fetal growth and normal. Regular blood glucose monitoring is recommended at least 2 times a week (ideally every day, if possible by means of self-examination at home). Recommended antenatal control schedule, getting close to the approximate birth control is increasingly frequent. Hb glikosilat ideally be checked once every 6-8 weeks. Maternal weight gain is recommended around 1-2.5 kg in the first trimester and then average 0.5 kg per week. Until the end of pregnancy, the recommended weight gain depends on the initial nutritional status of mothers (mothers less weight 14-20 kg, 12.5-17.5 kg of normal weight mothers and mothers more weight / obesity 7.5-12.5 kg). If the management of diet alone is not successful, then the insulin directly used. Insulin used to be human insulin preparations (human insulin), because insulin is not derived from a human (non-human insulin) can cause formation of antibodies against endogenous insulin and these antibodies can penetrate the blood barrier placenta (placental blood barrier) so that it can affect the fetus. At DMG, the insulin used is a low-dose insulin with intermediate and long work is given 1-2 times a day. In the DMH, insulin administration may be more frequent, can be combined between short-and intermediate-acting insulin, to achieve the expected glucose levels. Oral hypoglycemic drugs are not used in DMG because of the effects of high teratogenitasnya and can be excreted in large quantities through breast milk. Management of obstetric At the antenatal monitoring of maternal and fetal keadaanklinis, especially blood pressure, enlargement / fundus height, fetal heart rate, maternal blood sugar levels, ultrasound examination and kardiotokografi (if possible). At the level Polindes maternal and fetal monitoring performed by fundus height measurements and listening to the fetal heart rate. At the health center level monitoring of mother and fetus by uterine fundal height measurements and listening to the fetal heart rate. At the hospital level, maternal and fetal monitoring is done by: Fundus height measurements - NST - serial ultrasound - A thorough assessment with a score of dynamic fetal fetal placenta (FDJP), FDJP value <5 is a sign of fetal distress. - This assessment is done every week since 36 weeks of gestation. The presence of macrosomia, fetal growth stunted (IUGR) and fetal distress is an indication to perform a Caesarean section delivery. - In a healthy fetus, with a value FDJP> 6, can be born at the time of pregnancy (40-42 mg) with a normal delivery. Monitoring of fetal movement (normal> l0x/12 hours).

- Babies born to mothers DMG require special care.

- When will perform amniocentesis pregnancy termination should be done beforehand to ensure the maturity of the fetus (if gestational age <38 mg).

- Pregnancy DMG with complications (hypertension, preeclampsia, vascular abnormalities and infections such as glomerulonephritis, cystitis and monilisasis) should be treated since the age of 34 weeks gestation. DMG Patients with complications usually require insulin.

- The most ideal assessment is the assessment of fetuses with a score of fetal-placental function dynamic

do strict control in diabetes mellitus therapy for pregnant mothers