DIABETES MELLITUS
Approximately 2% of pregnancies
are complicated by dia-betes that either develops during pregnancy (gestational
diabetes) or was antecedent to pregnancy (pregestational diabetes mellitus). In either case, diabetes has significant
impli-cations for mother and fetus during pregnancy, and, conversely, pregnancy
significantly affects diabetes. Whether diabetes isnewly diagnosed or
long-standing, intense management may be stressful, and all those involved with
obstetric care should be mindful of the extra emotional attention many of these
patients need.
The American Diabetes Association
(ADA) identifies three forms of glucose intolerance:
Type 1
diabetes mellitus refers to diabetes diagnosedin
childhood. It is thought to be caused by immunologic destruction of cells of
the pancreas, resulting in necessary insulin
replacement. Diabetic ketoacidosis
(DKA) ismore common in patients with this type of diabetes
Type 2 diabetes
mellitus is adult-onset glucose intoler-ance. Patients with
type 2 diabetes mellitus are frequently overweight, and the disease can often
be controlled with weight control and a carefully followed diet. This type of
diabetes is thought to result from insulin resistance and exhaustion of the
cells, rather than their destruction.
Gestational
diabetes mellitus (GDM) refers to glu-cose intolerance
identified during pregnancy. In most patients, it subsides postpartum, although
glucose intol-erance in subsequent years occurs more frequently in this group
of patients.
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