Chapter 007. Medical Disorders during Pregnancy (Part 5)

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Diabetes Mellitus in Pregnancy: Treatment Pregnancy complicated by diabetes mellitus is associated with higher maternal and perinatal morbidity and mortality rates. Preconception counseling and treatment are important for the diabetic patient contemplating pregnancy and can reduce the risk of congenital malformations and improve pregnancy outcome. Folate supplementation reduces the incidence of fetal neural tube defects, which occur with greater frequency in fetuses of diabetic mothers. In addition, optimizing glucose control during key periods of organogenesis reduces other congenital anomalies including sacral agenesis, caudal dysplasia, renal agenesis, and ventricular septal defect. Once pregnancy is established, glucose control should be managed more...

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Chapter 007. Medical Disorders during Pregnancy (Part 5) Diabetes Mellitus in Pregnancy: Treatment Pregnancy complicated by diabetes mellitus is associated with higher maternal and perinatal morbidity and mortality rates. Preconception counseling and treatment are important for the diabetic patient contemplating pregnancy and can reduce the risk of congenital malformations and improve pregnancy outcome. Folate supplementation reduces the incidence of fetal neural tube defects, which occur with greater frequency in fetuses of diabetic mothers. In addition, optimizing glucose control during key periods of organogenesis reduces other congenital anomalies including sacral agenesis, caudal dysplasia, renal agenesis, and ventricular septal defect.
Once pregnancy is established, glucose control should be managed more aggressively than in the nonpregnant state. In addition to dietary changes, this requires more frequent blood glucose monitoring and often involves additional injections of insulin or conversion to an insulin pump. Fasting blood glucose levels should be maintained at
unless there is biochemical evidence of fetal lung maturity. In general, efforts to control glucose and maintain the pregnancy until the estimated date of delivery result in the best overall outcome for both mother and newborn. Gestational Diabetes All pregnant women should be screened for gestational diabetes unless they are in a low-risk group. Women at low risk for gestational diabetes are those
Pregnant women with gestational diabetes are at increased risk of preeclampsia, delivering infants who are large for their gestational age, and birth lacerations. Their fetuses are at risk of hypoglycemia and birth trauma (brachial plexus) injury. Gestational Diabetes: Treatment Treatment of gestational diabetes with a two-step strategy of dietary intervention followed by insulin injections if diet alone does not adequately control blood sugar [fasting glucose < 5.6 mmol/L (