Pregnancy and Diabetes Mellitus: An Overview

Abstract

DOI: http://dx.doi.org/10.5915/15-4-12427

Pregnancy 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.