الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
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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.