Diabetes Complicating Pregnancies: Presentation to Maskwacis Health Services, November 2012

Dr Ellen TothDr Ellen Toth

University of Alberta University of Alberta

Diabetes Specialist Diabetes Specialist

Diabetes Complicating pregnancies

Presentation to Maskwacis– November 2012

Diabetes Complicating pregnancies

Presentation to Maskwacis– November 2012

Pregnancy, Maskwacis, 2012

The epidemicPopulation growth Case finding

Behaviours

Environment

Diabetes

GeneticsModified from Engelgau

Pregnancy: Diabetes begets diabetes

Plan for this talk

Introduction

How does diabetes complicate pregancy?

What can be done? (Standing Strong)


Pregnancy

Diabetes begets diabetes?


Plan for this talk

Introduction

How does diabetes complicate pregancy?

What can be done? (Standing Strong)


Pregnancy and Diabetes

Pre-existing diabetes OR gestational diabetes both can have (epigenetic) consequences

The baby gets the increased glucose (and other good or bad nutrition) from the mother

This affects the baby’s pancreas: with lifelong consequences


Glucose crosses placenta, Insulin does not


Developmental trajectory

Sensitive

phase

Genetic devlopment Environmental

influences: nutrition etc

Epigenetic adaptation: modification of genes resulting in different phenotypes


The Barker Hypothesis

Also shown for cancer, diabetes, chronic lung disease


Prevalence of Gestational Diabetes: A: Pimas, B: Norway, C: African Americans, D: New York State


Consequences of poorly, uncontrolled or undiagnosed diabetes in pregnancy

Early miscarriages

Large babies (and birth complications)

Congenital defects: heart, spine, cleft palate, “prune belly”, hydrocephalus

Still births

Childhood obesity

DiabetesPregnancy, Maskwacis, 2012

Definitions

Pre-existing diabetes: Type 1 or Type 2 before conception

Type 2 can (often) be undiagnosed

Gestational diabetes: Type 1 or Type 2 first “recognised” during pregnancy

Either undiagnosed Type 2 (Overt)

Or predictor of Type 2

Very rarely Type 1


Definitions

Diabetes before pregnancy

Diabetes in early pregnancy

Diabetes in late pregnancy


What to do?

Know whether you have diabetes or not

Plan your pregnancy

Screening

Before pregnancy

In early pregnancy

(Universal screening recommended at 24- 28 weeks EXCEPT if increased risk factors)


Gestational Diabetes---Risk Factors

Overweight

Family history of diabetes

Over 25 years old

Previously delivered a large baby

Being of non-white heritage (ethnic groups)

Pregnant with more than one baby


Gestational Diabetes

Diabetes during pregnancy.

Causes: Hormones that help the baby develop can affect your own insulin's ability to handle sugar. This is a type of insulin resistance.

Both mother and child are at a higher risk of developing type 2 diabetes later in life.


Questions?


Diabetes Complicating Pregnancies: Presentation to Maskwacis Health Services, November 2012

Health & Medicine

Transcript of Diabetes Complicating Pregnancies: Presentation to Maskwacis Health Services, November 2012