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In this talk, I will discuss
pre-gestational diabetes,
its impact on mother
and the developing
child, and its management.
First to introduce
myself, I'm Jeremy Oats.
I'm an obstetrician with a
longstanding interest in the care
of women with diabetes, both
pre-gestational and gestational.
I work in the Diabetes Service
at the Royal Women's Hospital,
Melbourne, Australia,
which is a tertiary
referral University-affiliated hospital.
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Pre-gestational diabetes--
that is diabetes that predates
the pregnancy-- comprises
type 1 diabetes,
previously called insulin
dependent diabetes,
reflecting its autoimmune etiology
that results in the destruction
of the beta islet
cells of the pancreas.
And now increasingly,
type 2 diabetes.
It is caused by increasing insulin
resistance and an incapacity
of the beta islet cells to
secrete sufficient insulin
to maintain normoglycemia.
The other most common type
of diabetes in pregnancy
is gestational diabetes,
which is the subject
of a separate presentation.
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Incidence.
This pre-gestational diabetes
complicates between 0.2%
to 0.3% of pregnancies.
GDM used to affect 1%
to 5% of pregnancies.
But with the adoption of
the WHO IADPSG criteria,
this is increasing
to around 10% to 20%.
There is considerable ethnic
variation largely reflecting
the background of
type 2 diabetes rates.
Rates are reported to be low in
rural Melanesian women in Papua,
New Guinea, and high in groups
such as the American Indians,
including the well-documented Pima
Indians and other indigenous populations,
including the Australian Aboriginal
population, especially those who
moved from traditional
diets to ones dominated
by high-carbohydrate fast food.
Accurate estimates are hampered
by an incomplete ascertainment
within many communities
underdiagnosed as both type 2
diabetes and its
precursors, impaired
fasting glucose and
impaired glucose tolerance.
