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MS WordPerinatologist Corner - C.E.U/C.M.E. Modules
Diabetes In Pregnancy Series
Sponsored by The Indian Health Service Clinical Support Center
PART 1: Screening and Diagnosis
2. Background
Diabetes in pregnancy may be associated with significant morbidity and mortality for both the pregnant woman and her infant. Diabetes in pregnancy in the general Anglo population has a prevalence of about 4%.
Diabetes in pregnancy is increasing in AI/AN. Rates of diabetes in pregnancy in AI/AN range from 3.5 percent to over 15 percent. A review of PubMed reveals 28 articles on Alaska Coastal Indians (Murphy), Chippewa (Rith-Narjarian), Navajo (Straus, Steinhart, Sugarman), Pima (Pettitt), Tohon O'odham (Livingston), Yu'pik Eskimos (Murphy), and Zuni (Benjamin).
In the general population, approximately 40% of women will go on to develop overt type II diabetes within 15 years of the index pregnancy, but among AI/AN women, over half will develop overt diabetes in as little as 4 to 6 years after the index pregnancy. Cumulative incidence of diabetes was as high as 70% in studies that examined women up to 28 years postpartum. (Kim 2002)
During pregnancy diabetic women experience more pyelonephritis and preeclampsia, as well as an increased risk of dystocia and operative delivery. Perinatal mortality is also increased as a result of congenital anomalies, stillbirth, birth trauma, and shoulder dystocia secondary to fetal macrosomia.
Neonatal morbidity in infants of diabetic women includes hypoglycemia, polycythemia, hyperbilirubinemia, hypocalcemia, hypertrophic cardiomyopathy, and respiratory distress. Maternal hyperglycemia is also linked to long-term obesity and diabetes in their offspring.
For more information on this and other issues in this module, also see the ANMC Diabetes in Pregnancy Guidelines (WORD).
