IDM - TheInfantofthe DiabeticMother Maureen L. Tate LTC MC...

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The Infant of the  Diabetic Mother Maureen L. Tate LTC MC February, 2003
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Harmful effects on the fetus recognized over  100 years ago GDM----3 to 10 % IDDM --0.1 to 0.3 % Maternal Diabetes
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Introduction Discovery of insulin  Understanding of pathophysiology of diabetes Improved preconception counseling   1964 1984  maternal mortality 50%  9%  fetal mortality             21%  2%
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Introduction  morbidity not as striking  4 to 5 fold decrease morbidity d/o of fetal growth and birth trauma intrauterine and perinatal asphyxia polycythemia hyperbilirubinemia cardiomyopathy  postnatal metabolic disturbances
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What is the etiology of congenital  malformations associated with  diabetes?
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Congenital Malformations Overall incidence---5 to 9% 2-3 fold higher than general population Predominantly with IDDM Malformations of CNS seen most often Diversity-No malformation considered  pathognomonic 
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Congenital Malformations No increase in major congenital malformations  among offspring of Diabetic fathers Prediabetic women GDM after first trimester
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Suggests that  glycemic control during  embryogenesis is the main factor in the  origin of malformations
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Incidence of major malformations among  women without preconception counseling     SOURCE     n  % 1993 Willhoite   8/123 6.4 1991 Kitzmiller 12/110 10.9 1991 Greene 23/432 7.4 1984 Ballard 19/196 9.7 1983 Simpson 11/142 7.7 1978 Kitzmiller 13/137 9.5  1977 Gabbe 19/260 7.3  
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Congenital Malformations Impact of Pre-conception Counseling   Kitzmiller  (1991)   Pre-conception counseling           1.2 %   Referred at 6-30 weeks EGA     10.9 % Willhoite (1993)   Pre-conception counseling           1.6 %   No pre-conception counseling     6.5 %
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Congenital Malformations Freinkel  1980     Fuel Mediated Teratogenesis -- exposure of the  embryo to an abnormal metabolic environment during  the initial stages of embryogenesis results in abnormal  development of the embryo
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Congenital Malformations Hyperglycemia Hyperketonemia Oxygen-Free Radicals
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Hyperglycemia Specific ultrastructural changes Decreased embryo size   Yolk sac malformations - sparse, patchy, non-uniform capillaries -  rough ER, ribosomes, and mitochondria - abnormal transport of nutrients
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Hyperglycemia Other consequences: Arachadonic acid deficiency Accumulation of sorbitol  Deficiency of myo-inositol associated with CNS malformations
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Maternal Hyperglycemia Dose and time dependent Post implantation rat embryo 100% teratogenic dose 950  mg/dl D-glucose Day 10 primary neural tube defect Day 11 cardiac defects Day 12 no defects
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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IDM - TheInfantofthe DiabeticMother Maureen L. Tate LTC MC...

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