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Gestational diabetes in a previous pregnancy Given birth to a baby that weighed more than 4 kg A parent, brother or sister with type 2 diabetes Polycystic ovary syndrome or acanthosis nigricans darkened patches of skin.
All pregnant women without known pre-existing diabetes should be screened for gestational diabetes between 24 to 28 weeks of pregnancy If you were diagnosed with gestational diabetes during Titas malaysian cuisine pregnancy, it is important to: Breastfeed immediately after birth and for a minimum of 4 months in order to prevent hypoglycemia in your newborn, obesity in childhood, and diabetes for both you and your child Reduce your weight, targeting a normal body mass index in order to reduce your risk of gestational diabetes in the next pregnancy and developing type 2 diabetes Be screened for type 2 diabetes after your pregnancy: Introduction This chapter Titas malaysian cuisine pregnancy in both pre-existing diabetes type 1 and type 2 diabetes diagnosed prior to pregnancyovert diabetes diagnosed early in pregnancy and gestational diabetes GDM or glucose intolerance first recognized in pregnancy.
Some management principles are common to all types of diabetes. The prevalence of pre-existing diabetes has increased in the past decade 1 primarily as a result of the increase in type 2 diabetes 2. Studies of women with pre-existing diabetes show higher rates of complications compared to the general population, including perinatal mortality, congenital malformations, hypertension, preterm delivery, large-for-gestational-age LGA infants, caesarean delivery and other neonatal morbidities 1,3—5.
Preconception care Preconception care improves maternal and fetal outcomes in women with pre-existing diabetes. This involves educating women about the importance of optimal glycemic control prior to pregnancy, discontinuing potentially harmful medications and achieving a health body weight.
Hyperglycemia is teratogenic and if glycemic control is poor in the first few weeks of conception, the risk of congenital anomalies is increased. This may be caused, in part, by maternal obesity, especially in women with type 2 diabetes 10— Preconception care should also include advice regarding folic acid supplementation.
In 1 case-control study in the United States, women with diabetes who did not take folic acid containing vitamins were at a 3-fold higher rate of congenital anomalies compared to women with diabetes who did There are no intervention trials to support folic acid doses greater than 1 mg for women with diabetes.
Obesity, which is more common in women with type 2 diabetes, is associated with lower serum folate levels for the same intake, lower intake of folate rich foods and increased risk of neural tube defects independent of glycemic control 15— A higher dose of folic acid may be considered in women with obesity, although there is no clinical evidence that this higher dose reduces congenital anomalies.
Measurement of red blood cell RBC folate may also be useful to guide adjustment of folic acid dosage in women with obesity or women who have had bariatric surgery. The following factors are associated with women with pre-existing diabetes being less likely to receive preconception care: Additionally, some studies have shown that women with type 2 diabetes are less likely to receive preconception care compared to women with type 1 diabetes 19,23 Assessment and management of complications Retinopathy.
Women with type 1 24,25 and type 2 diabetes 26 should ideally have ophthalmological assessments before conception, during the first trimester, as needed during pregnancy, and within the first year postpartum 27, The risk of progression of retinopathy is increased with poor glycemic control during pregnancy, and progression may occur for up to 1 year postpartum 25, Additional risk factors for retinopathy progression include: Closer retinal surveillance is recommended for women with more severe pre-existing retinopathy, those with poor glycemic control or women with greater reductions in A1C during pregnancy 27, Laser photocoagulation for severe nonproliferative or proliferative retinopathy prior to pregnancy reduces the risk of visual impairment in pregnancy 34 ; if not performed prior to pregnancy, it is still considered safe to receive during pregnancy.
There is insufficient evidence to confirm safety or harm from the use of intravitreal antivascular endothelial growth factor anti-VEGF injections for diabetic macular edema or proliferative diabetic retinopathy during pregnancy Potential side effects include hypertension, proteinuria, defective embryogenesis and fetal loss 36, It is not known if these medications cross the placenta or if they are secreted in breastmilk.
Gestational timing of exposure needs to be considered in situations where potential benefit to the woman justifies the potential fetal risk.Shop Mikasa for a variety of bone china, dinnerware sets, drinkware& flatware. Compliment your stoneware or porcelain with fine table runners and linens.
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