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Perry Chapter 11key Points
Perry Chapter 11key Points
11
KEY POINTS
Diabetes mellitus, currently the most common endocrine disorder associated with pregnancy, occurs in approximately 4% to
14% of pregnant women. The perinatal mortality rate for wellmanaged diabetic pregnancies, excluding major congenital
malformations, is approximately the same as for any other
pregnancy.
The current diabetes classification system includes four groups:
type 1 diabetes, type 2 diabetes, other specific types (e.g., diabetes
caused by genetic defects in beta cell function or insulin action,
disease or injury of the pancreas, or drug-induced diabetes), and
gestational diabetes mellitus (GDM).
Dr. Priscilla White developed a classification system. Whites
system was based on the following: age at diagnosis; duration of
illness; and presence of end-organ involvement, especially eye
and kidney. Her classification system is still used frequently to
assess both maternal and fetal risk. Women in classes A through
C generally have positive pregnancy outcomes as long as their
blood glucose levels are well controlled. However, women in
classes D through T usually have poorer pregnancy outcomes
because they have already developed the vascular damage that
often accompanies long-standing diabetes.
Careful monitoring of blood glucose levels, insulin, or oral hypoglycemic medication administration when necessary and dietary
counseling are used to create a normal intrauterine environment
for fetal growth and development in the pregnancy complicated
by pregestational diabetes or GDM.
Poor maternal glycemic control before conception and during
pregnancy may be responsible for fetal congenital malformations
and maternal complications such as miscarriage, infection, and
dystocia (difficult labor) caused by macrosomia.
Preconception counseling is recommended for all women of
reproductive age who have diabetes because it is associated with
less perinatal mortality and fewer congenital anomalies.
Maternal insulin requirements increase as the pregnancy progresses and may quadruple by term as a result of insulin resistance created by placental hormones, insulinase, and cortisol.
In the immediate postpartum period insulin requirements
decrease substantially because the major source of insulin resistance, the placenta, has been removed. Women may require only
one third to one half of their last pregnancy insulin doses on the
first postpartum day, provided they are eating a full diet.
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
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A pregnant woman with epilepsy should take only one anticonvulsant medication, at the lowest dose level that is effective at
keeping her seizure free if at all possible.
Many autoimmune disorders (e.g., SLE and MG) are often diagnosed in women during their reproductive years; therefore they
may occur during pregnancy.
Women with SLE are advised to wait until they have been in
remission for at least 6 months before they attempt to become
pregnant.
Alcohol and other drugs easily pass from a mother to her baby
through the placenta. Smoking during pregnancy has serious
health risks, including bleeding complications, miscarriage, stillbirth, prematurity, low birth weight, and sudden unexplained
infant death. Congenital anomalies have occurred in infants of
mothers who have taken drugs.
Support from a variety of sources, including family and friends,
health care providers, and the recovery community, is needed
to help perinatal substance abusers achieve and maintain
sobriety.
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.