1. 5. GDM

2. Antepartum
• Fetal complication
• Maternal complications

3. Fetal
complication

4. Miscarriage
• early abortion is associated with poor
glycemic control
– HbA1c concentrations were > 12 percent
or
– persistent preprandial glucose
concentrations were > 120 mg/dL

5. Preterm Delivery
• the incidence of preterm birth was 28
percent
• a fivefold increase compared with that of
their normal population
• Related with poor control GDM or GDM
with hypertension

6. Fetal malformations
• related with poorly controlled diabetes during
both preconceptionally and early in pregnancy
• etiology was multifactorial
• Most common : CVS ( VSD ) , Skeletal system
( Caudal regression syndrome )
, neurovascular system ( NTD )
• Diabetes is not associated with increased risk
for fetal chromosomal abnormalities

7. Macrosomia
• infants whose birthweight exceeds 4000
g. or large-for-gestational age
• The incidence of macrosomia rises when
mean maternal blood
glucose concentrations > 130 mg/dL
• Maternal hyperglycemia fetal
hyperinsulinemia
• excessive fat deposition on the shoulders
and trunk, which predisposes them to
shoulder dystocia or cesarean delivery

8. IUGR
• Diabetic mothers with vascular
complication
uteroplacental insufficiency
IUGR
• Incidence : IUGR<<macrosomia

9. Unexplained Fetal
Demise• Unexplained
• These infants are typically large-for-gestational
age and die before labor, usually at 35 weeks or
later
• hyperglycemia-mediated chronic aberrations in
transport of oxygen and fetal metabolites
• maternal hyperglycemia>> osmotically induced
villous edema
>>impaired fetal oxygen transport
• increased frequency in
• severe preeclampsia
• vascular complications

10. Polyhydramnios
• fetal hyperglycemia causes polyuria
• amnionic fluid index related with amnionic
fluid glucose concentration

11. Maternal
complications

12. Diabetic Nephropathy
• Causes end-stage renal disease in is
nearly 30 percent in
individuals with type 1 diabetes and
ranges from 4 to 20 percent in those with
type 2 diabetes.
• end-stage renal failure at a mean of 6
years after dm
• the incidence of nephropathy in
individuals with type 1 diabetes
decline with glucose control

13. Diabetic Nephropathy
• nephropathy in type 1 disease begins with
microalbuminuria—30 to 300 mg/24 h of
albumin
• After another 5 to 10 years of overt
proteinuria more than 300 mg/24 hr
patient may develops end-stage renal
disease

14. Diabetic Nephropathy
• Diabetic patient with renal involvement are
at increased risk for preeclampsia
• no long-term sequelae of pregnancy on
diabetic nephropathy
• The incidence of either micro- or
macroalbuminuria was not
increased in women with prior
pregnancies compared with that of
nulliparas

15. Diabetic retinopathy
• related to duration of diabetes.
• first and most common visible lesions :
nonproliferative retinopathy
severity preproliferative
retinopathy
• pregnancy worsens proliferative
retinopathy
• laser photocoagulation and good glycemic
control during pregnancy decreases
progression

16. Diabetic Neuropathy
• Peripheral symmetrical sensorimotor
diabetic neuropathy is
uncommon in pregnant women.
• Most common : diabetic gastropathy in
pregnancy >> nausea and vomiting
• Treatment : metoclopramide and H2-
receptor antagonists

17. Diabetic Ketoacidosis
• 1-3 percent of diabetic pregnancies
• The incidence of fetal loss is about 20
percent with ketoacidosis
• Pregnant women usually have
ketoacidosis with lower blood
glucose levels than when nonpregnant

18. Preeclampsia
• risk factors for preeclampsia include any
vascular complications
• Hypertension is the major complication
that most often forces
preterm delivery in diabetic women.
• the perinatal mortality rate is increased
20-fold for preeclamptic
women with diabetes compared with that
for those who remain

19. Infections
• Almost all types of infections are
increased in diabetic pregnancies.
• 80% percent of type 1 diabetes develop
at least one infection
during pregnancy compared to 25 %
without diabetes
• wound complications after cesarean
delivery x2-3 times
• antepartum pyelonephritis xx 4 times

20. Common infections
• include candida vulvovaginitis,
• urinary infections,
• respiratory tract infections,
• puerperal pelvic infections