OBESITAS, DM GESTASIONAL

DAN KEHAMILAN

OBESITAS DI NEGERI MAJU

BUKAN JEPANG

OVERWEIGHT-BMI 25 29,9
OBESITY BMI > 30
WANITA > PRIA
1/3 ORANG AMERIKA OBESE
25 % WANITA AMERIKA
OVERWEIGHT, 25 % OBESE
MENINGKAT TERUS DALAM 100
TAHUN TERAKHIR-TIDAK
BERHASIL DITURUNKAN SEPERTI
MMR DI INDONESIA

ANGKA KEMATIAN PADA

OBESE
+ DM 4 X >
+ APPENDICITIS 2 X
+ KECELAKAAN >

Diabetes Mellitus

Metabolisme karbohidrat dalam kehamilan

Insulin ibu tdk dpt mencapai janin
Timbul Resistensi Insulin
Produksi rendah, Reseptor rusak
Mengakibatkan Hipoinsulin Ibu
Timbullah keadaan Hiperglikemi
Diabetes dalam Kehamilan
Timbul Hiperinsulin Janin

THE PHYSIOLOGIC FEEDBACK LOOP

OBESITY ( LEPTIN RESISTANCE)
FOOD INTAKE
ENERGY EXPENDITURE

FAT
CELLS
LEPTIN

PANCREAS

- HYPOTHALAMUS
(NPY AND OTHERS)
- SYMPATHETIC NERVOUS
SYSTEM

INSULIN

PENAPISAN DM GESTASIONAL
Low Risk
Blood glucose testing not routinely required if all of the following characteristics are
present :
Member of an ethnic group with a low prevalence of gestational diabetes
No known diabetes in first degree relatives
Age less than 25 years
Weight normal before pregnancy
No history of abnormal glucose metabolism
No history of poor obstetrical outcome
Average Risk
Perform blood glucose testing at 24 28 weeks using one of the following :
Average risk women of Hispanic, African, Native American, South of East Asian
origins
High risk women with marked obesity, strong family history of type 2 diabetes, prior
gestational diabetes, or glucosuria
High Risk
Perform blood glucose testing as soon as feasible : If gestational diabetes is not
diagnosed, blood glucose testing should be repeated at 24 28 weeks or at any time a
patient has symptoms or signs suggestive of hyperglycemia

SKRINING

WANITA RISIKO TINGGI

24-28 MINGGU
50 G LOADING
GLUKOSA PLASMA > 140 G%
DILANJUTKAN DENGAN TTGO
U/ DIAGNOSIS

DIAGNOSIS: TTGO

100 G BUKAN 75 G
GLUKOSA PLASMA
PUASA
1 JAM
2 JAM
3 JAM

DIAGNOSIS DM GESTASIONAL
Plasma Glucose ( mg/dL )a
Timing of
Measurement

National Diabetes
Data Group
( 1979 )

Carpenter and
Coustan ( 1982 )

Fasting

105

95

1 hr

190

180

2 hr

165

155

3 hr

145

140

BATASAN DAN KLASIFIKASI

DM GESTASIONAL

GANGGUAN TOLERANSI GLUKOSA BERBAGAI TINGKAT YANG MUNCUL ATAU DIDIAGNOSIS PERTAMA
KALI SAAT KEHAMILAN

2-HOUR
POSTPRANDIAL
GLUCOSE

THERAPY

CLASS

ONSET

FASTING PLASMA
GLUCOSE

A1

GESTATIONAL

< 105 mg/Dl

< 120 mg/dL

DIET

A2

GESTATIONAL

> 105 mg/dL

> 120 mg/dL

INSULIN

CLASS

AGE OF ONSET(yr)

DURATION (yr)

VASCULAR
DISEASE

THERAPY

OVER 20

< 10

NONE

INSULIN

10 19

10 19

NONE

INSULIN

BEFORE 10

> 20

BENIGN
RETINOPATHY

INSULIN

ANY

ANY

NEPHROPATHYa

INSULIN

ANY

ANY

PROLIFERATIVE
RETINOPATHY

INSULIN

ANY

ANY

HEART

INSULIN

Pengaruh terhadap kehamilan

Preeklampsi
Hidramnion
Kelainan letak janin
Abortus
Partus Prematurus

Pengaruh terhadap Persalinan

Inertia uteri
Distosia bahu
IUFD
Infeksi meningkat
SC meningkat
MMR meningkat

Pengaruh terhadap Nifas

Infeksi nifas
Sepsis
Wound Dehiscene

Pengaruh terhadap Janin

Cacat Bawaan
IUFD
Dismaturitas
Makrosomia
Kematian Noenatal
RDS

PENATALAKSANAAN
OBSTETRIS

BISA SAMPAI ATERM MAKSIMAL

40 MINGGU
TIDAK PERLU MENCARI
KELAINAN BAWAAN JANIN
Waspada MAKROSOMIA
PERVAGINAM, SC A/I
OBSTETRIS

Komplikasi

MAKROSOMIA DG SEGALA
AKIBATNYA:
DISTOSIA BAHU O/K VISEROMEGALI
TRAUMA PERSALINAN
JAUNDICE
SC MENINGKAT

DM nyata pada ibu

Obesitas dan DM nyata pada bayi

MAKROSOMIA

Hipertiroid dalam Kehamilan

Merupakan Hiperfungsi kelenjar Gondok

( Tiroid )
Insiden : 0,2 % kehamilan
Sering mengalami :
- Gangguan Haid
- Infertilitas

Klinis

Exopthalmus
Tremor
Berdebar - debar
Takikardi
Metabolisme basal meningkat
Hormon Tiroksin meningkat

Diagnostik

Adanya kelenjar gondok

Klinis
Laboratoris
TSHS, T3 dn FT4

Penatalaksanaan

Medis
- PTU
- Lugol
- Propanolol
Persalinan
- Pervaginam
- SC ai obstetris