DIABETES AND

PREGNANCY: A 13–YEAR
STUDY.

Jessica Bardales Mitac, M.D

John Essien, M.D
HOSPITAL GINECOBSTÉTRICO DOCENTE PROVINCIAL,
CAMAGÜEY, CUBA
 A Brief History
Eberts Papyrus Frequent and abundant
elimination of urine.”sweet
urine”
Ancient China Thirst disease

Other ancient cultures Excessive hunger

Celso( I b.c) Polyuria, Polydipsia

Areteo of Capodocia(II b.c) Diabetes(unquenchable

thirst)
1696 Evidence of Inheritance

Thomas Willis(1766) Presence of sugar

(Mellitus=Sugar)
Langerhans(Berlin, 1869) Islets
Bonting & Best(Canada) Pancreatic extract
Sanger(1960) Insulin Molecule
Beginning of XX Mortality rate 50%
Century Survival rate 40%

In Cuba 10th cause of mortality

Today
 Origin Genetic

Intervene in •Environmental Factors

lesser or •Immunological Factors
greater degree •Viral Infections

Hereditary Factors Extrinsic Factors

• Identical twin • Obesity
• Both parents diabetic • Stress
• One of the parents diabetic and • Pregnancy
the non diabetic parent with a • Infections
relative of the 1st order diabetic • Trauma
or a brother with a diabetic child.
PREGNANCY: A DIABETOGENIC EVENT
The woman is transformed from
a physiological point of view by:
• Nutritional demands by the fetus
• Metabolic changes in the mother
• Placenta as a site of exchange and
it’s hormonal effects:

-Insulin -Progesterone
Langerhans Islets -Glucagon -Estrogen
-Somatotropic Hormone
-Cortisol
-Adrenalin
-Thiroxin
-Placental lactogen
 COMPLICATIONS
DURING
GESTATION

Infections
Urinary
Toxemia Preterm Hidramnios Vaginal
labor
Acidosis
Vascular
Coma Retina
Renal
 A BALANCED DIET: A FUNDAMENTAL
PILLAR
OBJETIVES
 Reach and maintain a normal nutritional status.
 Obtain growth and development according to the
gestational age.
 Achieve an adecuate psycological and physical
capability.
 Obtain normal blood sugar levels all day
 Achieve normal levels of the diverse lipid
fractions in serum.
 Absence of macroangiopathic complications.
 Avoid the development of microangiopathies and
neuropathies.
 Maintain adecuate immunologic capacity against
infections.
 REPERCUSIONS ON:

Fetus
Embryo Newborn
Abortions
Malformations
Growth
alterations
Alterations of
MACROSOMIA
maturity
IUGR
Respiratory distress
Metabolic alterations
syndrome
Hypoglicemia
Distocia
Hyocalemia
Hyperbilirubinemia
Perinatal asphyxia
Policitemia
Results
 TABLE 1.
Age and Parity.
PARITY
AGE
0 1 2 AND ABOVE TOTAL
15 AND LESS 6 6
16-20 58 16 4 78
21-25 154 62 25 241
26-30 48 139 58 245
>30 88 151 151 390
TOTAL 354 368 238 960

SOURCE: FORM
 TABLE 2.
World Health Organization Classification and Prognosis.

W.H.O. CLASSIFICATION. PROGNOSIS

GMFP PMFP PMP TOTAL

Insulin Dependente 79 80 10 169
Insulin Independent 38 38

Gestational Diabetes 678 678

AGT Potential 39 39

AGT Praevia 36 36
TOTAL 870 80 10 960
SOURCE: Form P ≤0.05
LEGEND: GMFP- GOOD MATERNAL-FETAL PROGNOSIS
PMFP- POOR MATERNAL FETAL PROGNOSIS
PMP- POOR MATERNAL PROGNOSIS
 TABLE 3.
Nutritional Status and Weight gain.

WEIGHT NUTRITIONAL STATUS

GAIN(Kg.) Normal Low weight Over TOTAL
weight weight
2 and less 17 17 34
4-6 30 2 148 180
7-9 47 12 115 174
10-12 187 38 34 259
13-15 120 74 31 225
16and over 35 23 30 88
TOTAL 436 149 375 960
SOURCE: FORM P ≤0.05
 TABLE 4.
Treatment Administered
TREATMENT NUMBER PERCENTAGE

DIET 451 46.91

15-30 U 422 43.95
31-45 U 22 2.3
46-60 U 16 1.7
61-75 U 7 0.7
76-90 U 11 1.2
91-115 U 21 2.2
>115 U 10 1.04
TOTAL 960 100.00

SOURCE: FORM P ≤ 0.05

 TABLE 5.
Type of delivery and weight of the newborn

WEIGHT OF THE NEWBORN (GRAMS)

2499 AND 2500- 3000- 3500- 4000 AND
TYPE OF LESS 2999 3499 3999 MORE TOTAL
DELIVERY
Normal 23 84 311 95 25 538
Instrumentation 25 24 25 74
Primitive Cesarean 18 25 59 21 78 201
Reiterated Cesarean 27 31 27 33 29 147
TOTAL 68 165 397 173 157 960
SOURCE: FORM P ≤0.05
 TABLE 6.
Relation of Apgar Score at first and fifth minutes.

APGAR AT FIFTH MINUTE

APGAR
AT FIRST
MINUTE 4-6 7-10 TOTAL

0-3 2 8 10

4-6 6 39 45

7-10 891 891

TOTAL 8 938 946

SOURCE: FORM P ≤0.05

Conclusions
 The mean age of the women studied was
27,3±5,4 years.
 678 women of the universe of study had
gestational diabetes y 207 were known
diabetics.
 80 patients were evaluated as havingpoor
maternal-fetal prognosis, 10 were of poor
maternal prognosis and all were insulin-
dependent diabetics.
 Malnutrition was presented by the majority
of the gravidae.
 The control of Diabetes was achieved
using dietary measures in nearly half of the
universe.
 Distocic delivery was perforned in 432
parturients, of which 201 underwent
primitive cesarean section.
 The mean weight of the newborn was
3145±686 grams.
 Low Apgar Score at the fifth minute of life
was presented by 8 neonates.