Angelina L Trujillo Lorena Wright and Lois Jovanovic

Contents

Nutrition

Exercise

Insulin Therapy

Glucose Monitoring

Continuous Glucose Monitoring

Hemoglobin A1C

Medical Management of Complications During Diabetic Pregnancy

Nephropathy

Neuropathy

Lipid Changes During Pregnancy and Preexisting Diabetes Thyroid Disease in Preexisting Diabetic Pregnancy Management of Diabetic Ketoacidosis During Pregnancy Summary References

Abstract

Approximately 1.3% of pregnancies in the USA occur in women with preexisting diabetes mellitus. Women with pregestational diabetes mellitus who are in poor glycemic control during the first 7 weeks of pregnancy when fetal organogenesis is occurring have an increased incidence of spontaneous abortion and fetuses with congenital anomalies. Prepregnancy care of women with either type 1 diabetes mellitus (DM1) or type 2 diabetes mellitus (DM2) must include achievement of glucose control prior to conception to reduce the risk of maternal and fetal complications. Retinopathy, nephropathy, hypertension, and neuropathy each have an impact on the success of the pregnancy. Medical treatment of diabetes during pregnancy and treatment of coexisting diabetic complications will improve maternal and fetal outcome of pregnancies complicated by preexisting diabetes mellitus.

Key words: Pregestational; Diabetes; Pregnancy

From: Diabetes in Women: Pathophysiology and Therapy Edited by: A. Tsatsoulis et al. (eds.), DOI 10.1007/978-1-60327-250-6_17 © Humana Press, a part of Springer Science+Business Media, LLC 2009

Pregnancy complicated by preexisting diabetes mellitus has been estimated to occur in approximately 1.3% of pregnancies in the USA (1). Pregestational diabetes is a major risk factor for spontaneous abortions, congenital malformations, macrosomia, neonatal hypoglycemia, intrauterine death, and cesarean delivery (2, 3). Appropriate intensive therapy and maintenance of glucose levels to achieve a lowering of glycosylated hemoglobin (A1C), as close to the normal range, as possible without significant hypoglycemia before and throughout pregnancy can result in reducing the rate of fetal and maternal complications to a similar rate to that observed among nondiabetic pregnancies (4).

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