Periconceptional Care of Women with Diabetes Mellitus
Section snippets
Significance
In 1885, Le Corche [5] described, for the first time, the association between diabetes complicating pregnancy and congenital malformations. Pedersen [6] demonstrated that diabetic mothers were at high risk for birth defects. Since then, different types of malformations have been reported in infants born to diabetic women, with an estimated incidence of 6% to 10% [2]. The most commonly affected systems are cardiovascular, central nervous, gastrointestinal, genitourinary, and skeletal (Box 1) [7]
Nephropathy
Nephropathy complicates about 30% of women with type 1 DM. Overt nephropathy is defined as persistent proteinuria (more than 500 mg/24 hours of total protein or more than 300 mg/24 hours of urinary albumin excretion) observed in the first 20 weeks of pregnancy in the absence of urinary tract infection [36]. This condition is significantly correlated with the occurrence of maternal and fetal complications. Chronic hypertension and preeclampsia are observed in 40% of these subjects, retinopathy
Guidelines for preconception care
The main objectives of preconception counseling for diabetic women are the following:
- (1)
Folic acid administration and adequate blood glucose control before conception decrease the rate of major congenital anomalies. Monitoring HbA1c levels monthly until stable at a level of less than 1% above the upper limit of normal. Patients should also be educated regarding contraceptive use throughout this period.
- (2)
Evaluation with history, physical examination, and laboratory determinations for presence of
Summary
Pregestational diabetes is a common complication of pregnancy that can be associated with severe maternal and fetal morbidity. In addition, some women could have progression of diabetic complications secondary to pregnancy. Preconception care can significantly reduce pregnancy complications with a dramatic impact on the diabetic mother and her infant. For those women whose condition could be hastened by conception education, better understanding and an improved decision should be available to
References (60)
- et al.
Effect of hyperglycemia on sorbitol and myoinositol content of cultured rat conceptus: failure of aldose reductase inhibitors to midify myo-inositol depletion and dysmorphogenesis
Biochem Biophys Res Commun
(1986) - et al.
Characterization of differential gene expression profiles in diabetic embryopathy using DNA microarray analysis
Am J Obstet Gynecol
(2006) - et al.
Pregnancy outcome in patients with insulin-dependent diabetes mellitus with preconceptional diabetes control: a comparative study
Am J Obstet Gynecol
(1986) - et al.
Significant decrease in congenital malformations in newborn infants of an unselected population of diabetic women
Am J Obstet Gynecol
(1989) - et al.
Diabetic nephropathy and perinatal outcome
Am J Obstet Gynecol
(1981 Dec 1) - et al.
Does pregnancy increase the risk for development and progression of diabetic nephropathy?
Am J Obstet Gynecol
(1996) - et al.
Perinatal outcome and long-term follow up associated with modern management of diabetic nephropathy
Obstet Gynecol
(1996) - et al.
The Wisconsin epidemiologic study of diabetic retinopathy. IV. Diabetic macular edema
Ophthalmology
(1984) - et al.
Progression of diabetic retinopathy in pregnancy: association with hypertension in pregnancy
Am J Obstet Gynecol
(1992) - et al.
Management of diabetic pregnancy complicated by coronary artery disease and neuropathy
Obstet Gynecol Clin North Am
(1996)
Position statement. Diagnosis and classification of diabetes mellitus
American Diabetes Association Diabetes Care
Preconceptional care of women with diabetes
Position statement. Preconception care of women with diabetes
Diabetes Care
Glycemic control during early pregnancy and fetal malformations in women with type I diabetes mellitus
Diabetologia
Du Diabetic dans ses rapports avec la vie uterine menstruation, et al grusesse
Annales de Gynecologic
The pregnant diabetic and her newborn
Diabetic embryopathy: pathogenesis, prenatal diagnosis and prevention
Obstet Gynecol Surv
The syndrome of caudal dysplasia: a review, including etiologic considerations and evidence of heterogeneity
Pediatr Pathol
Brief clinical report: femoral hypoplasia-unusual facies syndrome
Am J Med Genet
The internal secretion of the pancreas
Best CH Can Med Assoc J
Management of the pregnant, insulin-dependent diabetic women
Diabetes Care
Rate and type of congenital anomalies among offspring of diabetic women
J Reprod Med
Pregnancy complicated by clinical diabetes mellitus
A study of 600 pregnancies Obstet Gynecol
Diabetes-related perinatal mortality and congenital fetal abnormality: a problem of audit
Diabet Med
Teratogenesis in diabetic mice treated with alloxan prior to conception
Arch Environ Health
Teratogenic effects of excess glucose on head-fold rat embryos in culture
Teratology
Effects of maternal diabetes on early embryogenesis II. Hyperglycemia induced exencephaly
Teratology
Ultrastructural analysis of malformations of the embryonic neural axis induced by in vitro hyperglycemic conditions
Teratology
Effects of hyperketonemia on mouse embryonic and fetal glucose metabolism in vitro
Teratology
Protection by free oxygen radical scavenging enzymes against glucose-induced embryonic malformations in vitro
Diabetologia
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Contraception for women with medical disorders
2014, Best Practice and Research: Clinical Obstetrics and GynaecologyCitation Excerpt :Each of these conditions also has substantial adverse effects on both mothers and infants during pregnancy. For example, maternal diabetes may deteriorate during pregnancy and be accompanied by pre-eclampsia, polyhydramnios and recurrent urinary tract infection, while the fetus may develop macrosomia, certain congenital abnormalities, intrauterine growth retardation, respiratory distress syndrome and hypoglycaemia [12]. Women who are significantly overweight (BMI between 25.0 and 29.9 kg/m2) commonly develop gestational diabetes, hypertension, pre-eclampsia and have increased risk of caesarean section.
Leg Cramps and Restless Legs Syndrome During Pregnancy
2009, Journal of Midwifery and Women's HealthCitation Excerpt :Diabetes is discussed below. Muscle cramping and weakness can be caused by diabetic nephropathy,27 the autosomal dominant disorder polycystic kidneys,26 and the ingestion of medications known to cause renal damage. These medications include nonsteroidal antiinflammatory agents (NSAIDs) and antibiotics, such as the cephalosporins, penicillin, nitrofurantoin, ampicillin, and sulfonamides.28
Maternal obesity and risk of neural tube defects: a metaanalysis
2008, American Journal of Obstetrics and GynecologyCitation Excerpt :Obesity is known to increase the likelihood of development of diabetes mellitus,70 and most people who later experience type 2 diabetes mellitus initially have impaired glucose tolerance.71 An association between maternal prepregnancy diabetes mellitus and an elevated risk of NTDs and other birth defects is well-recognized72,73; this risk is higher among women with poor glucose control in early pregnancy.74 A recent study suggests that features of metabolic syndrome (defined in that study as presence of prepregnancy diabetes mellitus, body weight ≥90th percentile value of control subjects, nonwhite ethnicity, and/or serum highly sensitive C-reactive protein ≥75th percentile of control subjects) increased the risk of NTDs.
Pregnancy as an Opportunity for Lifelong Health Promotion
2023, Women-Centered Care in Pregnancy and ChildbirthTwenty years of pediatric diabetes surveillance: what do we know and why it matters
2021, Annals of the New York Academy of Sciences