Diabetes and pregnacy
Journal Title: Postępy Nauk Medycznych - Year 2010, Vol 23, Issue 5
Abstract
Diabetes mellitus can occur during pregnancy in 2 forms: pregestational and gestational diabetes. Both types of diabetes need special care during pregnancy. Pregestational diabetes represents very high-risk obstetrics. Poor glucose control before conception and during organogenesis places the fetus at high risk of congenital malformations, especially cardiac and neural tube defects. Gestational diabetes confers a much lower risk for both the mother and the fetus but is growing in prevalence. It is a controversial entity, with conflicting guidelines. Recent studies show that diagnosis and management of this disorder have beneficial effects on maternal and neonatal outcomes, including reduced rates of shoulder dystocia, fractures, nerve palsies, and neonatal hypoglycemia. Diagnosis is made using a sequential model of universal screening with a 50-g one-hour glucose challenge test, followed by a diagnostic 75-g oral glucose tolerance test for women with a positive screening test. Treatment consists of glucose monitoring, dietary modification, exercise, and, when necessary, pharmacotherapy to maintain euglycemia. Insulin therapy is the mainstay of treatment, although glyburide and metformin may become more widely used. Women with gestational diabetes are at high risk of subsequent development of type 2 diabetes. Lifestyle modification should therefore be encouraged, along with regular screening for diabetes.
Authors and Affiliations
Magdalena Walicka, Ewa Czerwińska
Keywords
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