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Fetal Complications

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Comprehensive Clinical Approach to Diabetes During Pregnancy

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Abstract

Infants of diabetic mothers are at significant risk for major congenital anomalies. The overall reported risk for major malformations is 5–6%, with a higher prevalence of 10–12% in pregnancies requiring insulin therapy. The risk of isolated and multiple congenital anomalies appears to be highest in infants of mothers with pregestational diabetes. However, intensive treatment aiming to an optimal glycemic control during organogenesis can reduce the risk for congenital malformations. In addition, diabetes in pregnancy has been associated with increased fetal growth. According to Padersen hypothesis, maternal hyperglycaemia results in fetal hyperglycaemia and, hence, in hypertrophy of fetal islet tissue with insulin-hypersecretion. Increased insulin concentration is associated with fetal macrosomia, as fetal insulin is a primary anabolic factor for in utero fetal growth. Moreover, maternal lipids contribute to the fetal growth, in particular adiposity. Women with diabetes have significantly higher triglyceride concentrations and maternal triglyceride concentrations have a significant positive correlation with birth weight, independent of maternal glucose concentration. In pregnancies complicated by maternal diabetes mellitus, the increased incidence of late fetal death and intrapartum fetal distress may have its origins in chronic or acute fetal hypoxemia. The combination of glucose and insulin excess in the fetus stimulates its metabolism, and consequently increases the fetal oxygen demands, often leading to chronic fetal hypoxia and acidemia. As a response to hypoxia, erythropoietin (EPO) is produced. It has been proposed that fetal acidemia may be a consequence of short-term maternal hyperglycemia, whereas fetal polycythemia reflects poor long-term glycemic control. Insulin is the preferred treatment for pregestational diabetes in pregnancy. In case of gestational diabetes, if lifestyle modifications fail to achieve the glycemic targets, insulin is initiated.

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Authors and Affiliations

  1. 2nd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Christos Chatzakis, Alexandros Sotiriadis, Angeliki Gerede & Konstantinos Dinas

  2. Harris Birthright Research Centre for Fetal Medicine Research Institute, Kings College Hospital, London, UK

    Kypros H. Nicolaides

  3. Kings’ College London, London, UK

    Kypros H. Nicolaides

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  1. Christos Chatzakis
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  2. Alexandros Sotiriadis
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  3. Angeliki Gerede
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  4. Konstantinos Dinas
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  5. Kypros H. Nicolaides
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Correspondence to Alexandros Sotiriadis .

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  1. Unit of Reproductive Endocrinology, 1st Department of Reproductive Endocrinology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Dimitrios G. Goulis

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Chatzakis, C., Sotiriadis, A., Gerede, A., Dinas, K., Nicolaides, K.H. (2022). Fetal Complications. In: Goulis, D.G. (eds) Comprehensive Clinical Approach to Diabetes During Pregnancy. Springer, Cham. https://doi.org/10.1007/978-3-030-89243-2_16

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  • DOI: https://doi.org/10.1007/978-3-030-89243-2_16

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