20. Dietary advice in pregnancy
for preventing GDM
This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published
In The Cochrane Library, 2011, Issue 2
•20
21. • Glucose is the primary source of energy for fetal growth
(Moses 2006; Scholl 2004), making maternal glucose levels
influential on pregnancy outcomes - a primary consideration in
gestational diabete management.
• Glycaemic index (GI) qantitatively defines the effect of
carbohydrate based foods on blood glucose levels.
• The GI value of a food is the response of blood glucose to a
particular food, compared with an equivalent amount of the
standard glucose (Foster-Powell 2002).
•21
31. GDM에서 모유수유 해야하는 이유
① 혈당조절 효과
- 모유수유를 30분간 하면 50~100mg/dL 혈당 감소
- 임신성 당뇨병 산모의 4~12주 모유수유 후 공복혈당 낮아짐1)
(모유수유 93± 13, 인공수유 98± 17mg/dL)
② 열량 소모 : 평균 25%의 인슐린 요구량 감소1)
③ 모유수유를 최소2개월이상 한 임산부 자녀 :
그렇지 않은 경우보다 제 1형 당뇨병 이환 될 확률 감소2)
(당뇨병 예방에 도움이 되는 물질 함유)
④ 영아 소아비만과 초기 당뇨병에 대한 보호효과 2)
➄ 산후 당뇨병 예방3)
1) American Diabetes Association. (2009). Medical management of pregnancy complicated by diabetes.
2) Taylor, J. S., Kacmar, J E., Nothnagle, M., Lawrence, R. (2005). A systematic review of the literature associating breastfeeding with type 2 diabetes
and GDM. Journal of the American College of Nutrition, 24(5), 320-326.
3) Schwarz, E. B., Brown, J. S., Creasman, J. M. et al. (2010). Lactation and maternal risk of type 2 diabetes: Apopulation-based study.
The American Journal of Medicine, 123(9). 863e1-e6.
•31
34. • GDM affects 2-5% of all pregnancies in Korean
women.
• In a mixed ethnic population cohort of Chicago
USA, as much as 50% of GDM women
progressed to T2DM within 5 years Postpartum.
• Both environmental and genetic factors are
thought to contribute to the development of
T2DM after GDM
•34
35. Incidence of T2DM after GDM in Koreans
Ref> 곽수헌 (서울대병원 내분비내과, 2011 ICDM 발표자료)
•35
36. Postpartum complications
• Recurrence of GDM
: ~ 50% in Korean women
(Kwak SH et al, Diabetes Care 31: 1867, 2008)
• Development of T2DM
: 35-60% within 10 years
• A higher incidence of the metabolic syndrome
• Early atherosclerosis (endothelial dysfunction)
: increased risk of chronic hypertension and CVD
•36
37. Maternal follow-up
• CVD risk factor assessment
• Breast feeding
• Contraception or pregnancy planning
• Diabetes prevention
•37
39. Fetal Programing
• “자궁 안에서 출생후의 평생건강이 결정된다”
(David Baker, England, 1991)
- 임신 전 및 임신 중 영양부족
- 임신 중 스트레스
- 임신 중 탈수증 등
→ 저 체중아 출생 → 성인에서의 평생 건강의 질 ↓
각종 대사증후군 쉽게 노출된다는 이론
(당뇨, 고혈압, 고지혈증, 비만 등)
• 임신전과 임신 중 관리 강조
•39
42. Preconception care for diabetic women for
improving maternal and infant health
This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published
In The Cochrane Library, 2011, Issue 2
•42
43. • Current guidelines in many countries including Australia, the
United Kingdom and United States recommend
preconception care of diabetic women.
• Pregnant women with type I or type II diabetes are at a greater
risk of adverse outcomes in pregnancy such as high blood
pressure(gestational hypertension) and preterm births.
• Pregnancy can also accelerate the development of diabetic
complications(retinopathy, nephropathy, neuropathy,
ischaemic heart disease, cerebrovascular disease, peripheral
vascular disease).
•43
44. • Babies born to mothers with type I or type II diabetes
diagnosed before pregnancy may be larger and are at greater
risk of infant death and congenital abnormality (such as
neural tube defects including anencephaly and spina bifida).
• These infants are also at risk of developing type II diabetes
in the long term. Because of the strong association between
good control of a woman’s blood sugars (glycaemic control),
as measured by haemoglobinA1c, and reduced congenital
anomalies, glycaemic targets are central to preconception
care.
•44
47. • This review evaluating preconception care management
protocols for women with pre-existing diabetes identified only
one trial (involving 53 women) that was eligible for inclusion.
• None of the prespecified outcomes of the review were reported
by this trial.
• Haemoglobin A1c data were reported as mean changes from
baseline and could not be included in this review.
• Therefore, it is unclear what effect preconception care for
diabetic women has on maternal and infant health outcomes
based on evidence from randomised controlled trials.
•47
53. Pregnancy Outcomes in Pregnancy Women with
Type 1 and Type 2 Diabetes
Hee-Sook Kima, Moon-Young Kimb, Jeong-Eun Parkc, Sung-Hoon Kimc
a Collegeof Nursing, Seoul National University, Seoul, Korea
b Department of Obstetrics and Gynecology, c Diabetes Center, Division of Endocrinology & Metabolism, Department of Medicine,
Cheil General Hospital & Women’s Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
•53
54. Pregnancy Outcomes in Pregnancy women with
Type 2 diabetes & Nondiabetes Patient Matched Age,
Prepregnancy BMI and Parity
Hee-Sook Kima, Moon-Young Kimb, Jeong-Eun Parkc, Sung-Hoon Kimc
a College
of Nursing, Seoul National University, Seoul, Korea
b Department of Obstetrics andc Diabetes
Center, Division of Endocrinology & Metabolism, Department of Medicine,
Cheil General Hospital & Women’s Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
•54
55. Suggestion
• Teratogen Checklist & EMR 기록 추가
• 병원내 “고위험 임신교육과 자조모임”
운영과 활성화 : ex. GDM & PGDM
• Preconception Education 개발과 적용 :
대학생/가임기 여성/고위험 여성
“임신전 생식건강증진 교육프로그램
개발과 평가”
• 산후 T2DM 예방 프로그램 개발과 평가
•55
60. Protocol of an integrated self-management program
Times 1 2 3 4 5
Gestation (Weeks) 29-30 30-31 31-32 32-33 33-34
Topic Introduction Compliance Effects of GDM Compliance Care & Prevent of DM
& Management of self-management on maternal- of self-management in postpartum
of GDM newborn
Content • Check of SM list • Check of SM list • Check of SM list
• Q&A • Q&A • Q&A
• Introduction of GDM • Exercise • Prevent of DM
• Dietary • Stress management in postpartum
• Emotional support • Emotional support • Emotional support
• Taekyo • Taekyo • Taekyo
• Abdominal breathing • Abdominal • Abdominal breathing
breathing • Delivery
• Effects of GDM on • Breastfeeding
maternal-Newborn • Postpartum care
Method Small group meeting Telephone- Small group meeting Telephone- Small group meeting
(Education & Support) counseling (Education & Support) counseling (Education & Support)
GDM : Gestational Diabetes Mellitus, SM: Self-management
•60
62. Telephone counseling
My glucose level is 100.
What was your
But it’s really hard to control diet. glucose level
I’m frustrated. Because I can’t eat last week?
bread & ramen.
•62
