Gestational diabetes is a medical complication during pregnancy, which should be dealt carefully. Previously pregnancy was contraindicated in diabetes mellitus because of the increased risk of maternal and fetal morbidity and mortality.
After isolation of insulin by Banting and Best in 1921 management of pregnancy has become easy, maternal and fetal mortality and morbidity decreased.
Incidence:
•Incidence is 3 to 5% of all pregnancies according to South Asian perspective.
•Diabetes occurs in around 3.3% of all pregnancies in United states.
Carbohydrate metabolism during pregnancy:
•During first and early parts of the mid trimester there is increased sensitivity to insulin.
•Opposite occurs in third trimester.
That is why gestational diabetes is more common after 26 weeks.
Diabetogenic effects of pregnancy: •Insulin resistance
•Decreased ability of insulin to act effectively on target tissues.
Due to:
- Production of human placental lactogen.
- Increased production of cortisol, estriol, and progesterone.
-Increased insulin destruction by kidney and placenta.
Acclerated starvation:
•The rapid metabolic adaptation of fat metabolism was described by frienkel as accelerated starvation. •The metabolism is to facilitate fetal utilization of protein and non lipid fuel.
•The placental hormones oestradiol, human placental lactogen, progesterone are all responsible for this accelerated starvation.
After isolation of insulin by Banting and Best in 1921 management of pregnancy has become easy, maternal and fetal mortality and morbidity decreased.
Incidence:
•Incidence is 3 to 5% of all pregnancies according to South Asian perspective.
•Diabetes occurs in around 3.3% of all pregnancies in United states.
Carbohydrate metabolism during pregnancy:
•During first and early parts of the mid trimester there is increased sensitivity to insulin.
•Opposite occurs in third trimester.
That is why gestational diabetes is more common after 26 weeks.
Diabetogenic effects of pregnancy: •Insulin resistance
•Decreased ability of insulin to act effectively on target tissues.
Due to:
- Production of human placental lactogen.
- Increased production of cortisol, estriol, and progesterone.
-Increased insulin destruction by kidney and placenta.
Acclerated starvation:
•The rapid metabolic adaptation of fat metabolism was described by frienkel as accelerated starvation. •The metabolism is to facilitate fetal utilization of protein and non lipid fuel.
•The placental hormones oestradiol, human placental lactogen, progesterone are all responsible for this accelerated starvation.
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