Medical Nutritional Therapy for Pre-gestational and Gestational Diabetes Mellitus

Pregnancy causes a multitude of metabolic changes within a woman’s body in order to provide the proper nutrients to the developing fetus. In women with diabetes type 1, type 2, and GDM （gestational diabetes mellitus） these metabolic perturbations must be treated distinctly and aggressively to optimize fetal development and health. Pre-gestational diabetes （either type 1 or type 2） has the potential to subject the developing fetus to abnormal maternal glucose levels resulting in problems with organogenesis producing congenital abnormalities or spontaneous abortion. Furthermore, gestational diabetes mellitus presents after organogenesis in the second part of pregnancy, therefore the major risk for the fetus is macrosomia. Although the goal for dietary therapy for each of these disorders is the same which is euglycaemia, the means to achieve it are very different and somewhat controversial. In the case of gestational diabetes, the main stay of therapy is medical nutritional therapy whereas in insulin requiring diabetes, dietary therapy is compensated with pre-meal insulin injections. The metabolic changes in normal pregnancy will be presented followed by the general guidelines for pregnancy. Fetal complications associated with inadequate nutrition or metabolic perturbation will be briefly explored, followed by issues and treatment for gestational diabetes mellitus, with emphasis on specific dietary therapies for GDM.

Disseminated herpes simplex infection induced hepatitis during pregnancy mimicking HELLP syndrome,a diagnostic challenge

The disseminated herpes simplex virus 2(HSV-2)carries a high mortality rate in pregnant women if left unrec-ognized.It often presents as unrelieved fever and hepatitis.Diagnosis is challenging due to vague symptoms and potential overlap with other conditions.Pregnancy is a risk factor as it conforms to a partially immunocompro-mised state.Dissemination to the brain could be devastating,and the treatment requires intravenous antivirals like acyclovir.Fetal outcomes are variable based on previous case reports.We present a case of young female gravida 1 para 1 who presented with disseminated HSV infection mimicking HELLP(Hemolysis,Elevated Liver enzymes,and Low Platelets)syndrome.She responded well to intravenous acyclovir,and the fetus had a viable outcome at the 26th week of gestation.Early diagnosis can prevent progression to fulminant liver failure and the need for a liver transplant.