OBESITAS, DM GESTASIONAL

DAN KEHAMILAN
 OBESITAS DI NEGERI MAJU
BUKAN JEPANG

OVERWEIGHT-BMI 25 29,9
OBESITY BMI > 30
ANGKA KEMATIAN PADA
WANITA > PRIA OBESE
1/3 ORANG AMERIKA OBESE + DM 4 X >
25 % WANITA AMERIKA + APPENDICITIS 2 X
OVERWEIGHT, 25 % OBESE
+ KECELAKAAN >
MENINGKAT TERUS DALAM 100
TAHUN TERAKHIR-TIDAK
BERHASIL DITURUNKAN SEPERTI
MMR DI INDONESIA
 Diabetes Mellitus
Metabolisme karbohidrat dalam kehamilan
Insulin ibu tdk dpt mencapai janin
Timbul Resistensi Insulin
Produksi rendah, Reseptor rusak
Mengakibatkan Hipoinsulin Ibu
Timbullah keadaan Hiperglikemi
Diabetes dalam Kehamilan
Timbul Hiperinsulin Janin
 THE PHYSIOLOGIC FEEDBACK LOOP
OBESITY ( LEPTIN RESISTANCE)
FOOD INTAKE
ENERGY EXPENDITURE

FAT PANCREAS
CELLS

LEPTIN
- HYPOTHALAMUS
(NPY AND OTHERS)
- SYMPATHETIC NERVOUS
SYSTEM
INSULIN
 PENAPISAN DM GESTASIONAL
Low Risk
Blood glucose testing not routinely required if all of the following characteristics are
present :
Member of an ethnic group with a low prevalence of gestational diabetes
No known diabetes in first degree relatives
Age less than 25 years
Weight normal before pregnancy
No history of abnormal glucose metabolism
No history of poor obstetrical outcome
Average Risk
Perform blood glucose testing at 24 28 weeks using one of the following :
Average risk women of Hispanic, African, Native American, South of East Asian
origins
High risk women with marked obesity, strong family history of type 2 diabetes, prior
gestational diabetes, or glucosuria
High Risk
Perform blood glucose testing as soon as feasible : If gestational diabetes is not
diagnosed, blood glucose testing should be repeated at 24 28 weeks or at any time
a patient has symptoms or signs suggestive of hyperglycemia
SKRINING
WANITA RISIKO TINGGI
24-28 MINGGU
50 G LOADING
GLUKOSA PLASMA > 140 G%
DILANJUTKAN DENGAN TTGO
U/ DIAGNOSIS
DIAGNOSIS: TTGO
100 G BUKAN 75 G
GLUKOSA PLASMA
PUASA
1 JAM

2 JAM

3 JAM
 DIAGNOSIS DM GESTASIONAL

Plasma Glucose ( mg/dL )a

Timing of
National Diabetes
Measurement Carpenter and
Data Group
Coustan ( 1982 )
( 1979 )
Fasting 105 95

1 hr 190 180

2 hr 165 155

3 hr 145 140
 BATASAN DAN KLASIFIKASI
DM GESTASIONAL
GANGGUAN TOLERANSI GLUKOSA BERBAGAI TINGKAT YANG MUNCUL ATAU DIDIAGNOSIS
PERTAMA KALI SAAT KEHAMILAN

2-HOUR
FASTING PLASMA
CLASS ONSET POSTPRANDIAL THERAPY
GLUCOSE
GLUCOSE
A1 GESTATIONAL < 105 mg/Dl < 120 mg/dL DIET
A2 GESTATIONAL > 105 mg/dL > 120 mg/dL INSULIN
VASCULAR
CLASS AGE OF ONSET(yr) DURATION (yr) THERAPY
DISEASE
B OVER 20 < 10 NONE INSULIN
C 10 19 10 19 NONE INSULIN
BENIGN
D BEFORE 10 > 20 INSULIN
RETINOPATHY
F ANY ANY NEPHROPATHYa INSULIN
PROLIFERATIVE
R ANY ANY INSULIN
RETINOPATHY
H ANY ANY HEART INSULIN
Pengaruh terhadap kehamilan
Preeklampsi
Hidramnion
Kelainan letak janin
Abortus
Partus Prematurus
Pengaruh terhadap Persalinan
Inertia uteri
Distosia bahu
IUFD
Infeksi meningkat
SC meningkat
MMR meningkat
Pengaruh terhadap Nifas
Infeksi nifas
Sepsis
Wound Dehiscene
Pengaruh terhadap Janin
Cacat Bawaan
IUFD
Dismaturitas
Makrosomia
Kematian Noenatal
RDS
PENATALAKSANAAN
OBSTETRIS
BISA SAMPAI ATERM MAKSIMAL
40 MINGGU
TIDAK PERLU MENCARI
KELAINAN BAWAAN JANIN
Waspada MAKROSOMIA
PERVAGINAM, SC A/I
OBSTETRIS
 Komplikasi
MAKROSOMIA DG SEGALA
AKIBATNYA:
DISTOSIA BAHU O/K VISEROMEGALI
TRAUMA PERSALINAN

JAUNDICE

SC MENINGKAT

DM nyata pada ibu

Obesitas dan DM nyata pada bayi
MAKROSOMIA
Hipertiroid dalam Kehamilan
Merupakan Hiperfungsi kelenjar Gondok
( Tiroid )
Insiden : 0,2 % kehamilan
Sering mengalami :
- Gangguan Haid
- Infertilitas
Klinis
Exopthalmus
Tremor
Berdebar - debar
Takikardi
Metabolisme basal meningkat
Hormon Tiroksin meningkat
Diagnostik
Adanya kelenjar gondok
Klinis
Laboratoris
TSHS, T3 dn FT4
Penatalaksanaan
Medis
- PTU
- Lugol
- Propanolol
Persalinan
- Pervaginam
- SC ai obstetris