obsolete Diabetes mellitus of mother, with delivery

Diabetes Mellitus in Mothers: An Obsolete Condition

Diabetes mellitus, specifically insulin-dependent diabetes mellitus (IDDM) and noninsulin-dependent diabetes mellitus (NIDDM), are now considered outdated terms. However, they were once used to describe a condition where the mother had diabetes during pregnancy.

Prevalence and Risks

According to recent reports, approximately 15.8% of women experience hyperglycemia during their pregnancies. This can lead to various complications for both the mother and the infant. The risk of premature labor is significant, occurring in only one third of cases, while less than 25 percent of mothers died from diabetic coma.

Types of Diabetes

There are two main types of diabetes that can affect a mother during pregnancy: pregestational (type 1 or type 2) and gestational (diagnosed during pregnancy). The outcome is generally related to the onset and duration of glucose intolerance during pregnancy and maternal glycemic control.

Complications for Mother and Infant

When pregnancy is affected by diabetes, both mother and infant are at increased risk for multiple adverse outcomes. These can include:

• Premature labor
• Macrosomia (baby growing much larger than normal)
• Congenital anomalies
• Birth injury

Importance of Multidisciplinary Care

A multidisciplinary approach to care before, during, and after pregnancy is effective in managing diabetes-related complications for both mother and infant.

References:

[1] The terms insulin-dependent diabetes mellitus (IDDM) and noninsulin-dependent diabetes mellitus (NIDDM) are now obsolete. Pancreatic β-cell destruction can lead to various complications. [3] [2] Diabetes mellitus is a group of metabolic diseases characterized by chronic hyperglycemia resulting from defects in insulin secretion, insulin action, or both. [2] [4] The true prevalence of diabetes in pregnancy (including gestational diabetes and pregestational diabetes) is unknown, but recent reports have found approximately 15.8% of women experience hyperglycemia during their pregnancies. [14] [5] A multidisciplinary approach to care before, during, and after pregnancy is effective in managing diabetes-related complications for both mother and infant. [13]

Warning Signs and Symptoms in Mother

Mothers with gestational diabetes may not exhibit obvious warning signs or symptoms, but some possible indicators include:

• Increased thirst and more-frequent urination [6]
• Fatigue, blurred vision, extreme thirst, nausea, frequent bladder, vaginal, or skin infections, frequent urination, sugar in the urine [7]

These symptoms are often mild and may go unnoticed until a pregnancy care provider tests for gestational diabetes.

Complications at Delivery

A large baby (considered more than 9 pounds at delivery) may cause injury to the mother during a vaginal delivery. A very large baby may suffer broken bones or nerve damage during delivery [1].

Newborn Complications

Babies of diabetic mothers may have major birth defects in various systems, including:

• Heart and blood vessels
• Brain and spine
• Urinary system and kidneys
• Digestive system [8]

Additionally, newborns may experience symptoms such as: * Poor sucking * Lethargy * Weak cry * Seizures (sign of severe low blood sugar) * Poor feeding * Puffy face * Tremors or shaking shortly after birth [5]

Based on the provided context, it appears that you are looking for diagnostic tests related to diabetes mellitus in mothers who have delivered their babies.

According to search result [4], gestational diabetes is a condition where a pregnant woman has elevated glucose levels and other symptoms of diabetes, but did not have diabetes before she became pregnant. This condition can be diagnosed through various tests, including:

• Fasting plasma glucose test: This test measures the level of glucose in the blood after an overnight fast (search result [5] recommends this test for screening).
• HbA1C test: This test measures the average level of glucose in the blood over a period of time (search result [5] also recommends this test for screening).
• Untimed random plasma glucose test: This test measures the level of glucose in the blood at any given time (search result [5] recommends this test as an alternative to fasting plasma glucose).

Additionally, search result [9] mentions that the diagnosis of gestational diabetes is completed through a two-step approach with a 1-hr 50 gm glucose challenge test (GCT) followed by an oral glucose tolerance test (OGTT). The OGTT criteria for diagnosis of Diabetes Mellitus in Pregnancy and Gestational Diabetes are also mentioned in search result [12], which provides reference values for the diagnosis.

It's worth noting that these tests are typically performed during pregnancy to diagnose gestational diabetes, but may not be relevant for mothers who have already delivered their babies. However, if a mother has a history of gestational diabetes or other risk factors, her healthcare provider may recommend follow-up testing after delivery to ensure she does not have undiagnosed diabetes.

References: [4] - Gestational diabetes is a condition in which a pregnant woman has elevated glucose levels and other symptoms of diabetes—but did not have diabetes before she became pregnant. [5] - Recommends universal testing for diabetes with a fasting plasma glucose, HbA1C, or an untimed random plasma glucose at the first prenatal visit. [9] - Mentions that the diagnosis of gestational diabetes is completed through a two-step approach with a 1-hr 50 gm glucose challenge test (GCT) followed by an oral glucose tolerance test (OGTT). [12] - Provides reference values for the diagnosis of Diabetes Mellitus in Pregnancy and Gestational Diabetes.

Based on the provided context, it appears that you are asking about the drug treatment for diabetes in pregnancy, specifically after delivery.

Treatment Options

According to search result [3], preconception counseling should be incorporated into routine diabetes care, and effective contraception should be prescribed until an individual's treatment plan and A1C are optimized. This suggests that treatment planning is crucial before conception.

Regarding the treatment of diabetes in pregnancy itself, insulin is often considered the gold standard for managing hyperglycemia during pregnancy (search result [2]). However, recent studies have suggested that certain oral hypoglycemic agents, such as metformin and glyburide, may be safe and acceptable alternatives (search result [6]).

Post-Delivery Considerations

After delivery, the focus shifts to managing diabetes in the mother. Search result [11] mentions that women diagnosed with gestational diabetes are at increased risk for developing type 2 diabetes later in life. Therefore, post-delivery management of diabetes is crucial to prevent long-term complications.

In terms of specific treatment options after delivery, search result [13] states that insulin is the preferred medication for treating diabetes in pregnancy because it does not cross the placenta. Metformin and glyburide may be used but both cross the placenta to the fetus, with metformin likely crossing to a greater extent than glyburide.

Summary

In summary, the treatment of obsolete diabetes mellitus (i.e., diabetes that has occurred in pregnancy) after delivery typically involves insulin as the preferred medication. Other oral hypoglycemic agents like metformin and glyburide may also be used, but their use is subject to certain considerations due to their potential effects on the fetus.

References:

[2] Insulin is the gold standard for treatment of hyperglycemia during pregnancy... [3] Preconception counseling should be incorporated into routine diabetes care... [6] The oral agents glyburide and metformin are both recommended by many professional societies for the treatment of gestational diabetes mellitus (GDM). [11] Women diagnosed with GDM are at increased risk for developing diabetes (DM2) later in life’. [13] Insulin is the preferred medication for treating diabetes in pregnancy...

Based on the provided context, it appears that you are looking for information on the differential diagnosis of gestational diabetes mellitus (GDM) in mothers who have delivered a baby.

Definition and Prevalence Gestational diabetes mellitus (GDM) is defined as glucose intolerance with onset or first recognition during pregnancy [3]. It affects approximately 14% of pregnancies worldwide, representing around 18 million births annually [15].

Differential Diagnosis The differential diagnosis for GDM includes:

• Pre-existing type 1 or 2 diabetes: This can be ruled out by assessing the mother's medical history and performing a thorough physical examination [8].
• Other causes of glucose intolerance: These may include genetic syndromes, folic acid deficiency, and vitamin B12 deficiency [4, 5].
• Hyperglycemia diagnosed during pregnancy: This is considered to be GDM until it is reclassified in the postpartum period [9].

Complications and Risks GDM is associated with a range of short and long-term maternal and infant complications, including pre-eclampsia, pre-term birth, caesarean section, stillbirth, macrosomia, and large-for-gestational-age [12]. There is also an increased risk of later type 2 diabetes in both mother and offspring.

Diagnostic Criteria The diagnostic criteria for GDM include:

• 75g OGTT: This is a commonly used test to diagnose GDM. The reference values are as follows:
  • FBS < 92 mg/dl (5.1 mmol/l)
  • 2-hour plasma glucose < 140 mg/dl (7.8 mmol/l) [11]

Conclusion In conclusion, the differential diagnosis of GDM in mothers who have delivered a baby includes pre-existing type 1 or 2 diabetes, other causes of glucose intolerance, and hyperglycemia diagnosed during pregnancy. It is essential to perform a thorough physical examination and assess the mother's medical history to rule out these conditions.

References:

[3] Aug 8, 2024 — Gestational diabetes mellitus (GDM) is defined as glucose intolerance of variable degree