Endocrinology Book

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Gestational Diabetes Perinatal Mortality

Aka: Gestational Diabetes Perinatal Mortality
  1. 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
  2. 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%
  3. 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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