Welcome to the MedLibrary.org Wikipedia Supplement on Diabetes mellitus and pregnancy -- Please Click to Return to Front Page

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.

Contents 1 Physiology 2 Risks for the child 2.1 Birth defects 3 Risks for the mother 4 Classification 5 Treatment of pregnant women with diabetes 6 See also 7 Footnotes 8 External links

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.

Risks for the child

Miscarriage, growth restriction, growth acceleration, fetal obesity (macrosomia), polyhydramnios and birth defects.

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].

Risks for the mother

Disturbed blood glucose levels. Hypoglycaemia can occur without warning.

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.

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.

See also

• Diabetes mellitus
• Gestational diabetes
• Pregnancy

Footnotes

External links

• CDC’s National Center on Birth Defects and Developmental Disabilities

v • d • e Pregnancy Planning Birth control • Pre-conception counseling Conception Fertility awareness • Assisted reproductive technology (ZIFT, GIFT)  • In vitro fertilisation Detection HCG pregnancy strip test • Obstetric ultrasonography • Pregnancy test • Prenatal diagnosis • 3D ultrasound During pregnancy Amniotic fluid • Amniotic sac • Amniocentesis • Chorionic villus sampling • Prenatal care Pregnancy complications Diabetes mellitus and pregnancy • Ectopic pregnancy • Miscarriage • Molar pregnancy Birth preparation Lamaze  • Bradley Method Childbirth Midwifery • Doula  • Home birth

Wikipedia content modification information:

• This page was last modified on 3 September 2008, at 07:58.

Wikipedia Authorship and Review

Wikipedia content provided here is not reviewed directly by MedLibrary.org. Wikipedia content is authored by an open community of volunteers and is not produced by or in any way affiliated with MedLibrary.org.

Wikipedia Usage Guidelines

This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article on "Diabetes mellitus and pregnancy".

The URL for this specific entry is:

• http://medlibrary.org/medwiki/Diabetes_mellitus_and_pregnancy

All Wikipedia text is available under the terms of the GNU Free Documentation License. (See Copyrights for details). Wikipedia® is a registered trademark of the Wikimedia Foundation, Inc.