Pregestational diabetes in pregnancy: Complications, management, surveillance, and mechanisms of disease—A review

Shub, Alexis; Lappas, Martha

doi:10.1002/pd.5718

Cited by 21 publications

(27 citation statements)

References 87 publications

(132 reference statements)

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“…There is a paucity of high‐quality published data to guide third trimester fetal surveillance. Advice, particularly regarding Doppler assessment of fetal vessels, has been extrapolated from surveillance of the growth‐restricted fetus, so applicability in the setting of macrosomia secondary to diabetes is not clear 236,237 . Maternal assessment of fetal movements should take place from 28 weeks gestation and any decrease in fetal movements should be promptly reported to the health professional 238 .…”

Section: Type 1 Diabetes and Type 2 Diabetes: Management During Pregnmentioning

confidence: 99%

ADIPS 2020 guideline for pre‐existing diabetes and pregnancy

Rudland

Price

Hughes

et al. 2020

Aust NZ J Obst Gynaeco

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This is the full version of the Australasian Diabetes in Pregnancy Society (ADIPS) 2020 guideline for pre-existing diabetes and pregnancy. The guideline encompasses the management of women with pre-existing type 1 diabetes and type 2 diabetes in relation to pregnancy, including preconception, antepartum, intrapartum and postpartum care. The management of women with monogenic diabetes or cystic fibrosis-related diabetes in relation to pregnancy is also discussed. E19 V. L. Rudland et al. GUIDELINE DEVELOPMENT AND METHODOLOGY This guideline is a consensus-based guideline, designed to provide practical guidance to clinicians. It was developed with a multidisciplinary writing team including obstetricians, endocrinologists, obstetric physicians, credentialled diabetes educators (CDE), midwives, lactation consultants and accredited practising dietitians (APD) with expertise in diabetes in pregnancy. It had input from both Australian and New Zealand clinicians. The writing group members were drawn from a variety of clinical backgrounds, including practitioners from metropolitan, regional and rural/ remote settings. The guideline did not aim to meet the National Health and Medical Research Council standard for guidelines, and rating quality of evidence or strength of each recommendation was out of scope. There was no funding available and this work was completed on a purely voluntary basis. The literature was reviewed, and each member of the writing group was assigned a section of the guideline to write. Sections were then reviewed by all members, and a consensus of expert opinion was achieved. The guideline was reviewed by the Australasian Diabetes in Pregnancy Society (ADIPS) board, and then widely disseminated throughout Australia and New Zealand for stakeholder review, with feedback from 14 professional organisations and 17 ADIPS members (obstetricians, endocrinologists, midwives, dietitians). The guideline writing group would like to acknowledge the valuable and extensive feedback provided. Each item of feedback was reviewed by the writing group and a consensus decision was made in response to each item of feedback. There are key areas that this guideline does not address: 1. Routine pregnancy care: This guideline specifically addresses issues of pre-existing diabetes and pregnancy. It does not include details of routine pregnancy care. Women with pre-existing diabetes and pregnancy require all the usual preconception, antenatal, peripartum and postnatal care that every other woman requires. This guideline is designed to supplement all the usual guidelines for regular pregnancy care for all women. 2. Social determinants of disease are important contributors to the excess burden of type 2 diabetes in Aboriginal and Torres Strait Islander, Maori and Pasifika women. The relationship between social determinants of disease and disease management is critically important. The complexity of these important issues is beyond the scope of this document and cannot be given due consideration in this already lengthy clinical guid...

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Section: Type 1 Diabetes and Type 2 Diabetes: Management During Pregnmentioning

confidence: 99%

ADIPS 2020 guideline for pre‐existing diabetes and pregnancy

Rudland

Price

Hughes

et al. 2020

Aust NZ J Obst Gynaeco

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“…Nutritional stress is also harmful for embryo development and pregnancy. In a diabetic pregnancy, hyperglycemia has been related with congenital malformations in humans and animals (Eriksson and Wentzel, 2016;Shub and Lappas, 2020). Mimicking maternal diabetes with very high concentrations of glucose in culture reduces blastocyst development rates and trophectoderm cells, while increases apoptotic cell rates in bovine and mouse (Bermejo-Alvarez et al, 2012;Uhde et al, 2018).…”

Section: Embryo Apoptotic Responses To In Vitro and In Vivo Stress Somentioning

confidence: 99%

Senescence and Apoptosis During in vitro Embryo Development in a Bovine Model

Ramos‐Ibeas

Gimeno

Cañón-Beltrán

et al. 2020

Front. Cell Dev. Biol.

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According to the World Health Organization, infertility affects up to 14% of couples under reproductive age, leading to an exponential rise in the use of assisted reproduction as a route for conceiving a baby. In the same way, thousands of embryos are produced in cattle and other farm animals annually, leading to increased numbers of individuals born. All reproductive manipulations entail deviations of natural phenotypes and genotypes, with in vitro embryo technologies perhaps showing the biggest effects, although these alterations are still emerging. Most of these indications have been provided by animal models, in particular the bovine species, due to its similarities to human early embryo development. Oocytes and embryos are highly sensitive to environmental stress in vivo and in vitro. Thus, during in vitro culture, a number of stressful conditions affect embryonic quality and viability, inducing subfertility and/or long-term consequences that may reach the offspring. A high proportion of the embryos produced in vitro are arrested at a species-specific stage of development during the first cell divisions. These arrested embryos do not show signs of programmed cell death during early cleavage stages. Instead, defective in vitro produced embryos would enter a permanent cell cycle arrest compatible with cellular senescence, in which they show active metabolism and high reactive oxygen species levels. Later in development, mainly during the morula and blastocyst stages, apoptosis would mediate the elimination of certain cells, accomplishing both a physiological role in to balancing cell proliferation and death, and a pathological role preventing the transmission of damaged cells with an altered genome. The latter would acquire relevant importance in in vitro produced embryos that are submitted to stressful environmental stimuli. In this article, we review the mechanisms mediating apoptosis and senescence during early embryo development, with a focus on in vitro produced bovine embryos. Additionally, we shed light on the protective role of senescence and apoptosis to ensure that unhealthy cells and early embryos do not progress in development, avoiding long-term detrimental effects.

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“…Generally, the perinatal/neonatal specific risks of diabetes in pregnancy include spontaneous abortion (before the 24th week), foetal abnormalities, preeclampsia, perinatal death, macrosomia (>97th percentile), neonatal hypoglycaemia, hyperbilirubinemia and neonatal respiratory distress syndrome. In addition, women with pregestational T1DM may have an aggravation of diabetes microvascular complications such as retinopathy and nephropathy, while those with pregestational T2DM may have a worsening of preexisting chronic hypertension and obesity [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

“…Pregnancy is physiologically characterized by reduced insulin sensitivity due to the effects caused by placental hormones, such as human placental lactogen, progesterone, prolactin, placental growth hormone, and cortisol. This change in maternal metabolism is directed towards providing adequate nutrition for the foetus [5,6].…”

Section: Introductionmentioning

confidence: 99%

Maternal-foetal complications in pregnancy: a retrospective comparison between type 1 and type 2 diabetes mellitus

Guarnotta

Mineo

Giacchetto

et al. 2021

BMC Pregnancy Childbirth

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Background The aim of the study was a retrospective comparison of the differences in maternal-foetal outcomes between women with type 1 and type 2 diabetes mellitus (T1DM and T2DM). Methods A cohort of 135 patients with pregestational diabetes, 73 with T1DM (mean age 29 ± 5 years) and 62 with T2DM (mean age 33 ± 6 years), in intensive insulin treatment throughout pregnancy were evaluated. Clinical and metabolic parameters and the prevalence of maternal and foetal complications were assessed. Results Women with T1DM showed lower pregestational BMI (p < 0.001), pregestational weight (p < 0.001), weight at delivery (p < 0.001), ∆_total_insulin requirement (IR) at the first, second and third trimesters (all p < 0.001) and higher weight gain during pregnancy (p < 0.001), pregestational HbA1c (p = 0.040), HbA1c in the first (p = 0.004), second (p = 0.020) and third (p = 0.010) trimesters compared to T2DM. Women with T1DM had a higher risk of macrosomia (p = 0.005) than T2DM, while women with T2DM showed higher prevalence of abortion (p = 0.037) than T1DM. At multivariate analysis, pregestational BMI and ∆_total_IR of the first trimester were independently associated with abortion in T2DM, while weight gain during pregnancy was independently associated with macrosomia in T1DM. Conclusion Women with T1DM have a higher risk of macrosomia than T2DM due to weight gain throughout pregnancy. By contrast, women with T2DM have a higher risk of spontaneous abortion than T1DM, due to pregestational BMI and ∆_total_IR in the first trimester.

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Pregestational diabetes in pregnancy: Complications, management, surveillance, and mechanisms of disease—A review

Cited by 21 publications

References 87 publications

ADIPS 2020 guideline for pre‐existing diabetes and pregnancy

ADIPS 2020 guideline for pre‐existing diabetes and pregnancy

Senescence and Apoptosis During in vitro Embryo Development in a Bovine Model

Maternal-foetal complications in pregnancy: a retrospective comparison between type 1 and type 2 diabetes mellitus

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