Pre-gestational diabetes and pregnancy

Published on October 7, 2014   29 min

A selection of talks on Metabolism & Nutrition

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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.
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.
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.