Pregnancy and Diabetes Mellitus: An Overview
Keywords: Diabetes Mellitus, Pregnancy, Diagnosis, Management, Results, Fetal Surveillance, Fetal Lung Maturity
DOI: http://dx.doi.org/10.5915/15-4-12427Pregnancy is not anymore rare in diabetic patients. Insulin therapy drastically reduced maternal mortality and morbidity. Perinatal mortality in diabetic pregnancies continued to be relatively high until the last decade. Marked reduction occurred since then and has been attributed to several factors: better understanding of the physiologic changes in carbohydrate metabolism in pregnancy, and the emphasis on the maintenance of glucose homeostasis in diabetic pregnancies as near to normal as possible, the introduction of methods to assess fetal well being and fetal lung maturity, and advances in neonatal intensive care. Active screening programs have been established to identify gestational diabetics. These patients' metabolic derangement can be controlled by dieting alone. Known diabetics require insulin, in addition. Insulin therapy should be continually adjusted to maintain euglycemic levels. Diabetic patients should be followed closely and monitored for any complications. Fetal well being should be evaluated using NST's, CST's, serial estriols, ultrasonography, and amniocentesis. Timing of delivery should depend on the adequacy of metabolic control, the presence of complications and on the results of fetal well being and fetal lung maturity studies. Modern management has resulted in marked reduction in perinatal mortality and morbidity. However, the increased incidence of congenital malformations in infants of diabetic mothers has not yet been reduced. Tight diabetic control in early pregnancy and probably also preconceptionally might be crucial in this regard.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).