Definition:Any that alteration in the metabolism of carbohydrates that are first detected during pregnancy.
• Inadequate adaptation to insulin resistance that occurs in pregnancy.
• Includes a small group of pregnant women with diabetes mellitus type I or II not previously diagnosed.

diabeties

• The association of diabetes and pregnancy has a frequency between 1 and 5%, varying in relation to the population analyzed by geographic area and the diagnostic criteria used
• Represents about 90% of pregnant women with diabetes and high risk obstetric conditions if not diagnosed or not treated properly
Physiology
First Quarter:
• There is hyperplasia of cls. pancreatic beta and increased sensitivity of these to glucose, the effect of estrogen and progesterone
• Increased sensitivity to insulin action at peripheral level
Consequence: Decreased fasting and postprandial glycemia away

Pathophysiologic
• High resistance to insulin of the same magnitude in normal pregnant women and diabetes, but is three times greater than that observed outside pregnancy.
• Predominantly located in the muscle tissue and is mediated by the cellular effects produced by placental hormones, especially placental lactogen and free cortisol.
Gestational Diabetes
It is usually asymptomatic disease and therefore must be sought dirigidamente.


Risk Factors
• Family history of diabetes
• previous gestational diabetes
• History of unexplained stillbirth
• History of RNGEG or macrosomic
• Current Fetus growing on P/90
• previous or current polyhydramnios
• Obesity

Physiology
• The maternal and fetal insulin-dependent maternal glycemia
• Fetal growth is not dependent on growth hormone, but the insulin.
• Insulin is the main anabolic hormone Maternal Fetal Risks:
• Metabolic decompensation
• Development of the long-term DM
• Associated Pathologies

Risk Fetal
• Macrosomia
• Trauma
• Neonatal Metabolic Complications

Diagnosis
Screening:
• Blood sugar overload post 50 g glucose (VN <140 mg per hour) • Sensitivity 80% • Specificity 87% • Test Glucose Tolerance (75 ml.) • With 10 to 14 hrs. fast and without carbohydrate restriction prior. • Administer 75 grs. glucose in 300 ml. water in 5 minutes. • If the blood glucose at 2 hrs. post overload is> 140 mg / dl makes the diagnosis of GDM

Treatment
Metabolic Control:
• Diet
• Monitoring blood glucose
• Insulin therapy
Obstetric:
• Monitoring Fetal Wellbeing
• Survey of Complications
• Associated pathology detection
Adjournment:
• Patients with good control and without complications at term interruption.
• Patients with poor control, macrosomia and associated pathology interruption at 38 weeks.
Route of Delivery:
• Main risk is particularly obstetric trauma shoulder retention.
• If the EPF is> 4500 gm. Electiva Elective Caesarean section is performed
Tracking:
• Postpartum: Management usual
• Control: Perform TTG at 6 to 12 weeks and that 10 to 20% of patients with metabolic abnormalities persist.
• Standard: Up to 40 to 50% are long-term diabetes.

PREVENTION
• It is suggested to perform universal screening in populations with high prevalence of this condition.
• This includes Hispanic, Native American, Asian and Indigenous Australians

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