.

1-14%


1o

2 3

(,
, , o
)

(3
)

..

.-2 (80-90%)

(MODY,
..1) 4-6-%

 ..

(
>4kgr)
(20%)

 Screening
GDM

 Screening
GDM

 ..

10 35-60% GDM
2

HbA1c.

>126 mg/dl
.

92 mg/dl <126 mg/dl

..

<92 mg/dl, OGTT

24-28 .

1 ..

(>4 kgr)

OGTT*
75 gr (24 -28 )

92 mgr/dl

1 h 180 mgr/dl

2h 153 mgr/dl

8 3 >150
g/24 /

*Standards of medical care in diabetes-2012.Diabetes Care 2012, 35(1): S11-S63.



..2

,
.

H

*

*Lowe LP et all,the HAPO Study Cooperative Research Group. Hyperglycemia and Adverse

Pregnancy Outcome (HAPO) Study: Associations of maternal A1C and glucose with pregnancy
outcomes. Diabetes Care. 2012 Mar;35(3):574-580. Epub 2012 Feb 1.

70-95 mg/dl

1 h 90-130 mg/dl

2 h 80-120 mg/dl


35-45% / ( )

20-25 %

30-40% ( )

25kcal /kg , 1800 kcal

,

,

30

Kcal/Kg
(Kg)
12-15
7

27-29

25

10-12

22-26

30

12-14

< 22

40

15-18


30 24

( )

*Catalano PM et all. The Hyperglycemia and Adverse Pregnancy Outcome Study:

Associations of GDM and obesity with pregnancy outcomes., the HAPO Study
Cooperative Research Group, Diabetes Care. 2012 Feb 22. [Epub ahead of print]

.: 140-150/90-100 mmHg ( )
:

.>150/100mmHg
(
)

: iv
Methyldopa, labetalol,

.<150/100
mmHg
(,
,

FOLLOW UP
HbA1c
2
6 (
) 4 (
3 )

.<140/90 mmHg

,
1,2

(glyburide-):

3,4
5

1- Nicholson W et all. Benefits and risks of oral diabetes agents compared with insulin in
women with gestational diabetes: a systematic review. Obstet Gynecol. 2009;113(1):193
2- Dhulkotia JS et all. Oral hypoglycemic agents vs insulin in management of gestational diabetes: a systematic review and metaanalysis. Am J Obstet
Gynecol. 2010;203(5):457.e1
3- Elliott BD et all. Insignificant transfer of glyburide occurs across the human placenta. Am J Obstet Gynecol. 1991;165(4 Pt 1):807.
4-Hebert MF et all. Are we optimizing gestational diabetes treatment with glyburide? The pharmacologic basis for better clinical practice.Clin Pharmacol
Ther. 2009;85(6):607.
5- Langer O et all. A comparison of glyburide and insulin in women with gestational diabetes mellitus. N Engl J Med. 2000;343(16):1134.

 :
A 2 -3 , 1/3

6- Vanky E et all. Placental passage of metformin in women with polycystic ovary syndrome. Fertil Steril.
2005;83(5):1575

:
95mg/dl
1 130-140 mg.dl
2 120 mg/dl

15
.

U/S

Regular
NPH

Lispro-Humalog
Aspart-Novorapid

lispro aspart
7

regular

detemir 10

glargine in vitr
in
vivo8
9

H NPH

7-Nicholson Wk et all. Therapeutic management, delivery, and postpartum risk assessment and screening in gestational diabetes. Evid
Rep Technol Assess (Full Rep). 2008
8-Pollex EK et all. Insulin glargine safety in pregnancy: a transplacental transfer study. Diabetes Care. 2010;33(1):29.)
9-Egerman RS et all. Perinatal outcomes in pregnancies managed with antenatal insulin glargine. Am J Perinatol. 2009;26(8):591.
10-Mathiesen ER et all. Basal insulin analogues in diabetic pregnancy: a literature review and baseline results of a randomised,
controlled trial in type 1 diabetes. Diabetes Metab Res Rev., 2011 Sep;27(6):543-51.


NPH
.(8-16
NPH 95-120 mg/dl)

NPH aspart
lispro regular ( 1 130-180
mg/dl 2-4 regular lispro aspart
)

- >100
mg/dl NPH 4-6

(basal bolus) (NPH 2-3

3)

(NPH/REGULAR 70/30) (biphasic

insoulin aspart 70/30 biphasic insoulin lispro
25/75, 50/50)

Jovanovic L et all. Treatment with insulin and its analogs in pregnancies complicated by diabetes. Diabetes Care. 2007;30 Suppl
2:S220.


0,2-1 /kg .( 0,2/kg .)

25% NPH () lispro

aspart (25% x 3)


> 95 mg/dl
NPH 1-2

<70mg/dl
NPH 1-2

>130mg/dl 1
1-2

04:00 >100 mg/dl

NPH 2 .

6-7

1 2

2-4 .

-
80-110 mg/dl

iv /

1 3

2-3

75-g 2-h OGTT

75-g 2-h OGTT

75-g 2-h OGTT

75-g 2-h OGTT


..*

HbA1c< 6.5 %(
)

70-100 mg/dl
90-140 mg/dl

Stop -EA, -1 -Ca

Stop

:
(GFR:<40)
.

* John L. Kitzmiller et all. Managing Preexisting Diabetes for Pregnancy. Summary of evidence and consensus recommendations for
care. Diabetes Care. 2008, 31(5): 1060-1079