4/25/2015
The adverse effects of diabetes
The perinatal morbidity and mortality
Miscarriage, preterm birth and fetal
death
Congenital malformation
Macrosomia
Fetal injury
hydramnios
Hypoglycemia
Respiratory distress syndrome
The congenital malformation
50% of perinatal death
2/3 of the anomalies involve the
cardovascular system or CNS
Cardiovascular malformation occur 3-9% of
diabetic pregnancy
Anencephaly & spina bifida 13 -20 times
more frequently compared with nondiabetic
mothers
The overt diabetes has more adverse effects
than the GDM.
The adverse effects on the fetus
The adverse effects on the pregnant women.
Miscarriage, preterm birth and fetal
death
Hyperglycemia can results in the
elevated the incidence of Miscarriage,
preterm birth and fetal death.
In general, Miscarriage, preterm birth
and fetal death are more rare in GDM
population than in overt population.
Macrosomia
Glucose can cross the placenta.
The Maternal hyperglycemia can cause
the fetal hyperglycemia.
The hyperglycemia would stimulate the
growth of fetus, then macrosomia will
occur.
1

Fetal growth restriction
The fetal growth restriction can be seen
in the women with overt diabetes, which
is related to the vascular disorders.
If women with diabetes during
pregnancy could not get sufficient
energy, the fetal growth will be
influenced.
Hypoglycemia
The fetus produces its own insulin to
modulate its blood glucose.
The hyperinsulinemia will occur in
response to the hyperglycemia in the fetus.
After delivery, the blood glucose provided
by mother will be stopped, but the insulin
production would not be reduced, so the
hyperglycemia will results in the newborns.
The adverse effects on the mother
Elevated incidence of the preeclampsia.
Dystocia
Infection
Ketoacidosis
4/25/2015
Hydramnios
Although diabetic pregnancies are often
complicated by hydramnios, the cause is unclear.
A likely explanation is that fetal hyperglycemia
causes polyuria. In a study from Parkland Hospital,
Dashe and co-workers (2000) found that the
amnionic fluid index parallels the amnionic fluid
glucose level among women with diabetes.
This finding suggests that the hydramnios
associated with diabetes is a result of increased
amnionic fluid glucose concentration.
Respiratory distress syndrome
The newborn respiratory distress
syndrome is related to the fetal lung
immaturity.
Hyperinsulinemia inhibits fetal lung
maturity.
So diabetes can result in the respiratory
distress syndrome.
Preeclampsia
Preeclampsia is related to glucose control .
Insulin resistance is causeof GDM and
associated with development of Preeclampsia
Hypertension that is induced or exacerbated
by pregnancy is the major complication that
most often forces preterm delivery in diabetic
women.
2

Distocia
Distocia is associated with macrosomia.
Should distocia can results into serious
birth trauma.
Long term complication
Fetal :
Metabolic risk
Infant of a Diabetic Mother (IDMs) have an
increased risk of developing diabetes
IDMs with mother history type 1 DM risk
2% DM type 1
IDMs with mother history type 2 DM risk
5-10 times DM type 2
GDM increase the Offspring Risk of Obesity
& impared glucosa metabolism
Maternal :
Development of type 2 diabetes
Diabetes related vascular disease
Chronic hypertension
4/25/2015
Ketoacidosis
Although it affects only approximately 1
percent of diabetic pregnancies,
ketoacidosis remains one of the most
serious complication .
The incidence of fetal loss is about 20
percent with ketoacidosis .
Neurocognitive development
In a study of 212 preschool children, Nomura et al
found that maternal GDM and low socioeconomic
status were associated with an increased risk for
attention deficit/hyperactivity disorder (ADHD)
at age 6
Cardiovascular risk factors
born to mothers with diabetes exhibited
higher levels of biomarkers for endothelial
damage and inflammation
TAKE HOME MESSAGES
Komplikasi GDM dibedakan menjadi jangka
pendek dan jangka panjang
Lebih mudah penangan komplikasi jangka
pendek
Penangan sejak dini pada ibu hamil dengan
GDM akan menghindari komplikasi jangka
panjang
Komplikasi jangka panjang sangat merugikan
bagi generasi yang akan datang.
3
4/25/2015