|
Overview :
White developed a classification for women with diabetes
mellitus during pregnancy that can help identify those at increased risk for
complications.
|
Criterion |
Class |
|
gestational diabetes, insulin not required |
A1 |
|
gestational diabetes, insulin required |
A2 |
|
age of onset >= 20 years (maturity onset
diabetes) |
B1 |
|
duration < 10 years, no vascular lesions |
B2 |
|
age of onset 10-19 years of age |
C1 |
|
duration 10-19 years, no vascular lesions |
C2 |
|
age of onset < 10 years of age |
D1 |
|
duration >= 20 years |
D2 |
|
benign retinopathy |
D3 |
|
calcified arteries of legs |
D4 |
|
calcified arteries of pelvis (no longer sought) |
E |
|
nephropathy |
F |
|
many failures |
G |
|
cardiopathy |
H |
|
proliferating retinopathy |
R |
|
renal transplant |
T |
from White, Tables II and III, page 229; Evans page 123
where:
• Table II
shows Class B to be composed of B1 and B2 criterion. I separated these out to
match the handling of Classes C and D.
• White
uses <10, 10-19, and "over 20" to specify age of onset and duration. Evans et
al use <10, 10-20, and > 20.
• In Evans
et al, type A is termed gestational diabetes, with A1 not requiring insulin and
A2 requiring insulin.
• In
White's paper, Class A is divided according to the subtypes of chemical diabetes
of Tyson and Felig:
|
Criterion
(Tyson and Felig) |
Class |
|
chemical diabetes with glycosuria, positive glucose
tolerance test and insulinopenia |
A1 |
|
chemical diabetes with glycosuria, positive glucose
tolerance test and hyperinsulinism |
A2 |
|
chemical diabetes with obesity, positive glucose
tolerance test and insulinopenia |
A3 |
|
|
Evans AT,
deVeciana M, Benbarka MM. Chapter 9: Endocrine disorders. pages 121-151 (page
123). IN: Niswander KR, Evans AT. Manual of Obstetrics, Fifth Edition. Little,
Brown and Company, 1996.
Tyson JE,
Felig P. Medical aspects of diabetes in pregnancy and the diabetogenic effects
of oral contraceptives. Med Clin North Am. 1971; 55: 947.
White P.
Classification of obstetric diabetes. Am J Obstet Gynecol. 1978; 130:
228-230.
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