medical notes

Apr 18th, 2015
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DIABETES MELLITUS IN PREGNANCYCHO Metabolism in PregnancyIncrease HPL and cortisol - relative insulin resistance in mother Most marked in 3rd trimesterTo balance these changes in normal pregnancy maternal pancreas secretes increased amount of insulin to maintain CHO metabolism.Resultfall in fasting glucose levelglucose levels higher than normal after CHO challengeTo foetus by facilitated diffusion across placenta. Level closely follows maternal levelDiabetes may complicate pregnancy either because:-Pre- existing insulin - dependent diabetesImpaired glucose tolerance during course of pregnancySchematic diagram of metablic alterations in D. mellitus in late pregnancy (In absence of appropriate therapy) Foetus MacrosomiaMotherPlacentaHPL ProgesteroneOestrogen Risk factors for development of diabetes in pregnancyObesity (body mass index 30)Family historyPrevious baby > 4.5kgPrevious unexplained stillbirthPrevious congenital abnormalityDefinition of diabetesWHO - either as a :-Raised fasting blood glucose level of >7.8mmol/L orA level of >11.1mmo/L 1-2 hours following a 75 grams glucose load.There is direct relationship between blood glucose levels and incidence of foetal and maternal complications - hence good diabetic control in pregnancy crucial.Hence ad

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