Diabetes mellitus and pregnancy
From Wikipedia, the free encyclopedia
For women with diabetes mellitus, pregnancy can present some particular challenges for both mother and child. If the woman who is pregnant has diabetes or develops diabetes during pregnancy, it can cause early labor, birth defects, and very large babies.
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[edit] Physiology
During a normal pregnancy, many physiological changes occur that influence blood glucose levels, such as a glucose-'drain' to the fetus, slowed emptying of the stomach, increased excretion of glucose by the kidneys and resistance of cells to insulin.
[edit] Risks for the child
Miscarriage, growth restriction, growth acceleration, fetal obesity (macrosomia), polyhydramnios and birth defects.
[edit] Birth defects
Birth defects are not currently an identified risk for the child of women with gestational diabetes, since this primarily occur in the latter part of pregnancy, where vital organs already have taken their most essential shape.
Still, having diabetes type I or II has a 2-3 [1] fold increase in risk of birth defects. The cause is e.g. oxidative stress, by activating protein kinase C[1] and lead to apoptosis of some cells[1].
[edit] Risks for the mother
Disturbed blood glucose levels. Hypoglycaemia can occur without warning.
[edit] Classification
The White classification, named after Priscilla White[2] who pioneered in research on the effect of diabetes types on perinatal outcome, is widely used to assess maternal and fetal risk. It distinguishes between gestational diabetes (type A) and diabetes that existed prior to pregnancy (pregestational diabetes). These two groups are further subdivided according to their associated risks and management.[3]
There are 2 classes of gestational diabetes (diabetes which began during pregnancy):
- Class A1: gestational diabetes; diet controlled
- Class A2: gestational diabetes; insulin controlled
The second group of diabetes which existed prior to pregnancy can be split up into these classes:
- Class B: onset at age 20 or older or with duration of less than 10 years
- Class C: onset at age 10-19 or duration of 10-19 years
- Class D: onset before age 10 or duration greater than 20 years
- Class F: diabetic nephropathy
- Class R: proliferative retinopathy
- Class RF: retinopathy and nephropathy
- Class H: ischemic heart disease
- Class T: prior kidney transplant
An early age of onset or long-standing disease comes with greater risks, hence the first three subtypes.
[edit] Treatment of pregnant women with diabetes
Blood glucose levels in the pregnant woman should be regulated as strictly as possible. In diabetes mellitus type 2, oral antidiabetic drugs should be replaced with insulin.
[edit] See also
[edit] Footnotes
- ^ a b c [http://publications.uu.se/theses/spikblad.xsql?dbid=7203 Author: Gäreskog, Mattias Title: Teratogenicity Involved in Experimental Diabetic Pregnancy]
- ^ White P. Pregnancy complicating diabetes. Am J Med 1949; 7: 609. PMID 15396063
- ^ Gabbe S.G., Niebyl J.R., Simpson J.L. OBSTETRICS: Normal and Problem Pregnancies. Fourth edition. Churchill Livingstone, New York, 2002. ISBN 0-443-06572-1
[edit] External links
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