IN THE NAME OF GOD

DIABETES SCREENING IN PREGNANCY

PANEL DISCUSSION IN THE NAME OF GOD Panel Discussion Laleh Eslamian MD, Prof of Obstet & Gynecol, Perinatologist, Shariati hospital, TUMS DIABETES SCREENING IN PREGNANCYScreening for Gestational DiabetesPopulation: all pregnant women.Recommendation: Screen @ 24-28w Screen high risks @ 1st prenatal visit if normal repeat @ 24-28wScreening tests: 2 step:50g GCT, measure BS @ 1h(ACOG) 1 step:75g GTT, measure FBS & BS @ 1h &2h(IASPDG, WHO)Interventions: 2 step, if 1h BS>140mg/dl: perform 100g GTT 1 step, 1 abnormal value = GDMBenefits of detection & early Tx: Reduces macrosomia, preeclampsia, CPD , birth trauma & C/S.

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Most commonly used guidelines for Dx of GDMOrganizationFasting Plasma Glucose mg/dlGlucose challenge1st h PG mg/dl2nd h PG mg/dl3rd h PG mg/dlWHO 12675g OGTTNot required 140Not requiredACOG 95

100g OGTT 180

154 140Canadian diabetes association 95

75g OGTT

190 160

Not required

IADPSG 92

75g OGTT 180 153

Not required

International Association of Diabetes in Pregnancy 2010Everybody @ 1st visit have either:1)FPS 5.1-7mmol/L(92-126mg/dl): Dx of GDM2)Random plasma glucose> 11mmol/L(198mg/dl): need OGTT3)HBA1C>6.5: need OGTTEverybody @24-28w OGTT

Panel Discussion HIV INFECTION & PREGNANCYHIV infectionMedical care of HIV-infected pregnant women: favorable maternal health outcomes & low rates of perinatal HIV transmission.Screen for anemia, HBV & HCV infections.Maternal viral load> 1000 copies/ml near term: CS @ 38w to reduce perinatal HIV transmission.Intrapartum , Tx with zidovudine depends on maternal plasma viral load.Breastfeeding is not recommended.Panel Discussion OBESITY & PREGNANCYObesityBMI 30kg/m2Compared to BMI