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Abstract Gestation diabetes mellitus, a carbohydrate intolerance that is discovered for the first time during pregnancy, ranges from insulin-dependent diabetes to mild degrees of hyperglycemia but in most cases is only sub clinically present (Schwartz and Brennert, 1990). None the less, it is essential that gestation diabetes mellitus be diagnosed and glucose levels be controlled, be cause increased perinatal morbidity and mortality in the newborns of mothers with uncontrolled gestation diabetes have been demonstrated (O’Sullivan eta/ 1995), during the second or third trimester when levels of insulin-antagonist hormones increase and insulin resistance usually occurs. Approximately 90.000 women with G.D.M give birth each year. G.D.M. may go undetected in up to 50% of cases. The effects of GDM include: macrosomia, birth trauma due to difficult delivery, shoulder dystocia, hypoglycemia ad hyperbilirubinemia (London eta/, 1990). Diabetes in pregnancy is encountered in approximately 3:4% of all pregnancies in Egypt (M.O.H, 1994). The morbidity associated with pregnancies by diabetes may be substantial , since diabetes may result in adverse pregnancy outcomes. Therefore the combination of diabetes and pregnancy presents a special challenge in public health setting. Opportunities to improve the outcomes of the public sector can improve pregnancy outcomes among women with established and women m whom GDM which is detected by several methods include: I. Identification (including out reach, screenmg, and diagnosis). 2. Care/referral (including appropriate patient education, nutrition , counseling and referrals to high risk centers or to private care) 3. Maternal I neonatal follow-up and 4. Professional education. |