Diabetes mellitus and pregnancy

For women with diabetes mellitus, pregnancy can present some particular challenges for both mother and child. If the woman who is pregnant has diabetes or develops diabetes during pregnancy, it can cause early labor, birth defects, and very large babies.

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Physiology

During a normal pregnancy, a lot of physiological changes occur that influence blood glucose levels, such as a glucose-'drain' to the fetus, slowed emptying of the stomach, increased excretion of glucose by the kidneys and resistance of cells to insulin.

Risks for the child

Miscarriage, growth restriction, growth acceleration, fetal obesity (macrosomia), polyhydramnios. Birth defects are not currently an identified risk for the child of women with gestational diabetes.

Risks for the mother

Disturbed blood glucose levels. Hypoglycaemia can occur without warning.

Classification

The White classification, named after Priscilla White^[1] who pioneered in research on the effect of diabetes types on perinatal outcome, is widely used to assess maternal and fetal risk. It distinguishes between gestational diabetes (type A) and diabetes that existed prior to pregnancy (pregestational diabetes). These two groups are further subdivided according to their associated risks and management.^[2]

There are 2 subtypes of gestational diabetes (diabetes which began during pregnancy):

• Type A1: abnormal oral glucose tolerance test (OGTT) but normal blood glucose levels during fasting and 2 hours after meals; diet modification is sufficient to control glucose levels
• Type A2: abnormal OGTT compouned by abnormal glucose levels during fasting and/or after meals; additional therapy with insulin or other medications is required

The second group of diabetes which existed prior to pregnancy can be split up into these subtypes:

• Type B: onset at age 20 or older or with duration of less than 10 years
• Type C: onset at age 10-19 or duration of 10-19 years
• Type D: onset before age 10 or duration greater than 20 years
• Type F: associated diabetic nephropathy
• Type R: associated diabetic retinopathy
• Type H: diabetes with ischemic heart disease
• Type T: diabetes requiring kidney transplant

An early age of onset or long-standing disease comes with greater risks, hence the first three subtypes.

Treatment of pregnant women with diabetes

Blood glucose levels in the pregnant woman should be regulated as strictly as possible. In diabetes mellitus type 2, oral antidiabetic drugs should be replaced with insulin.

See also

• Diabetes mellitus
• Gestational diabetes
• Pregnancy