II. Precautions

  1. Data listed is from studies that predated current aggressive Gestational Diabetes Management
  2. Current guideline-based Gestational Diabetes Management has dramatically reduced perinatal mortality

III. Epidemiology: Glucose Control related to perinatal mortality

  1. General
    1. Overall Gestational Diabetes Perinatal Mortality: 16.3%
    2. Gestational Diabetic Ketoacidosis confers 50-80% perinatal mortality
  2. American Study (1972)
    1. Glucose <100: Perinatal mortality 3.4%
    2. Glucose 101-150: Perinatal mortality 16%
    3. Glucose >150: Perinatal mortality 24%
  3. British Study (1965)
    1. Glucose <150: Perinatal mortality 7.6%
    2. Glucose 151-200: Perinatal mortality 21%
    3. Glucose >200: Perinatal mortality 38%

IV. Classification: White's Classification of Diabetes (Mortality 1946-72)

  1. Class A (5% Mortality)
    1. Definition
      1. Abnormal Glucose Tolerance Test
      2. No clinical signs of Diabetes Mellitus
    2. Sub-classification
      1. A1 Diabetic: diet controlled
      2. A2 Diabetic: Insulin controlled
  2. Class B (13.9% Mortality)
    1. Diabetes Mellitus diagnosed after age 20 years or
    2. Diabetes Mellitus present less than 10 years and
    3. No Peripheral Vascular Disease
  3. Class C (18.1% Mortality)
    1. Diabetes Mellitus diagnosed age 10 to 19 years or
    2. Diabetes Mellitus present 10-19 years and
    3. No Peripheral Vascular Disease
  4. Class D (17.9% Mortality)
    1. Diabetes Mellitus diagnosed under age 10 years or
    2. Diabetes Mellitus present more than 20 years or
    3. Peripheral Vascular Disease or
    4. Retinopthy
  5. Class F (35.4% Mortality)
    1. Nephropathy
  6. Class H
    1. Cardiac Disease
  7. Class R
    1. Proliferative Retinopathy
  8. Class T
    1. History of Transplant

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