Diabetes in Pregnancy

Abstract

ABSTRACT Gestational diabetes mellitus is carbohydrate intolerance with onset or first recognition during pregnancy. Pregnancy could also occur in a woman with pre-existing diabetes. Congenital anomalies, macrosomia, birth injuries, obstetric and neonatal complications are associated with diabetes in pregnancy. The long-term implications in both mother and offspring include the development of obesity, metabolic syndrome and diabetes. Screening would identify patients and many guidelines exist for the same. Universal screening is advocated. The glycemic goals are stringent, although data indicate that thresholds should be lowered further. Nutritional therapy is the mainstay of treatment. Insulin is the agent of choice if glycemic goals are not met. Newer insulin analogs are advantageous. Oral antidiabetic agents show promise for the future, although more long-term trials are needed. Self monitoring of glucose is an important tool in the management of diabetes in pregnancy. Rates of cesarean section are high in diabetic pregnancies. If macrosomia occurs, other obstetric complications ensue. Maternal hyperglycemia can lead to neonatal hypoglycemia. Postpartum, maternal glycemic status should be reassessed and treatment modified accordingly. In the long-term, both mother and offspring are ideal candidates for lifestyle modification for the prevention of type 2 diabetes. Preconception care in women with pre-existing diabetes and/or its complications is desirable to minimize complications and congenital anomalies.