Pregnancy in type 1 diabetes mellitus: How special are special issues?

Abstract

India leads the world with largest number of diabetics earning the dubious distinction of “the diabetes capital of the world.” Diabetes is associated with maternal and perinatal morbidity and mortality. The number of pregnant women with pre-existing diabetes is increasing, mainly from an increase in type 2 diabetes, but also an increase in type 1 diabetes. Overall, type 1 diabetes accounts for approximately 5% to 10% of all diabetes outside of pregnancy, and in pregnancy put together with type 2 account for 10% of diabetic pregnancies. Management of the pregnant diabetic woman is a complex task that ideally begins before conception. Specific attention is required for diabetic pregnancies in different trimesters of pregnancy. Diabetes, especially type 1 diabetes, can be a challenge in pregnancy, but with education, close monitoring, and latest therapeutic modalities, these women can have healthy newborns. Close attention to diet, glycemic control, metabolic stresses, and early diagnosis and monitoring of complications can make pregnancy a successful experience for women with diabetes. A MedLine search was done to review relevant articles in English literature on diabetes and pregnancy, and specific issues related to pregnancy in type 1 diabetes were reviewed.

Obstetric Management of a Pregnant With Type I Diabetes and Poor Metabolic Control - A Case Report

“…Regarding the route of delivery, the vaginal route is the one indicated [9]. For the decision between the induction of labor or elective cesarean, some factors should be considered such as gestational age, nulliparity, maternal obesity, history of traumatic delivery or macrosomia, Bishop's index, metabolic balance in pregnancy and the presence of changes in fetal growth, namely: Discrepancy between abdominal perimeter and cephalic perimeter greater than 50 mm, abdominal perimeter higher than the 95 th percentile or fetal weight estimate greater than 4500 g in the term.…”

“…Hospital admission allows adjustment of diet, insulin therapy, monitoring of adherence to the treatment plan and the indirect evaluation of the socioeconomic context in which the pregnant woman is inserted [9].…”

“…In the absence preconception optimization or the knowledge of the patient health status, additional tests should be performed during the 1 st trimester, namely, renal function, protein-creatinine ratio in an occasional sample of urine, thyroid function (thyroid dysfunction around 40%), electrocardiogram for screening for ischemic heart disease and ophthalmologic examination to exclude retinopathy [8,9].…”

Preterm Birth and/or Factors that Lead to Preterm Delivery: Effects on the Neonatal Kidney

“…This increase in body weight is a result of excessive amounts of glucose and other nutrients crossing the placenta leading to an increase in fetal body growth. In contrast, when maternal diabetes (both Type 1 and Type 2) is severe, this can lead to IUGR in the infant [76,79]; the impacts of IUGR on the kidney are described later. With the increased prevalence of maternal diabetes there have been a number of recent studies looking at the effects on the fetal kidney.…”

“…Exposure to intrauterine maternal diabetes can significantly influence fetal growth throughout gestation and lead to an early onset to preterm birth; this is of concern given the recent rise in Type 1 and type 2 and/or gestational diabetes [75,76]. A common consequence of intrauterine exposure to maternal diabetes is macrosomia, in particular asymmetric macrosomia [77].…”