Diabetes mellitus in pregnant women poses problems for the mother, fetus and child. Women with established diabetes may have menstrual problem and difficulties in pregnancy. Pregnancy by itself worsens diabetic control and may cause certain diabetic complications to progress in women. Maternal diabetes is also hazardous for the fetus and carries increased risk for fetal loss and major congenital malformations.
However nowadays most women of childbearing age can realistically expect to become mothers of healthy children with intensive glycemic control. Improvements have ranged from technological advances in fetal surveillance, [ultrasound scanning] home glucose monitoring and intensive insulin regimens and have enabled even women with multiple diabetic complications to have successful pregnancies.
Mellitus Pregnancy
Diabetes mellitus in pregnancy is divided into pre-gestational and gestational diabetes.If diabetes is found for the first time in a pregnant women, where it was not there before, is called gestational diabetes. Approximately 7% of all pregnancies are complicated by GDM [gestational diabetes mellitus]. Normal pregnancy reduces insulin sensitivity because of diabetogenic effects of placental hormones. Gestational diabetes resolves after delivery, but may recur in subsequent pregnancies and a lifetime risk for developing type 2 diabetes is 30%.
INDICATIONS FOR DETECTION OF DIABETES IN PREGNANT WOMEN.
1]Family history of diabetes.
2]Glucose in urine sample.
3]History of unexplained perinatal loss.
4]History of large baby.
5]History of congenitally malformation infant.
6]Maternal obesity.
7]Maternal age more than 25 years.
8]Members of ethical/racial group with high prevalence of diabetes mellitus.
To prevent excess spontaneous abortion and congenial malformation in infants of diabetic mothers, diabetes care and education must begin before conception. There are no contraceptive methods that are specifically contraindicated in women with diabetes. The selection of a method should focus on methods with proven high degree of effectiveness. Once patient achieved stable sugar control than conception can be discontinued and plan for pregnancy.
Management during pregnancy.
1]Quiet smoking/alcohol.
2]Home blood glucose monitoring.
3]Diet control/folate supplementation.
4]Regular exercise.
5]Fetal monitoring by ultrasound scan.
6]Accurate insulin regimen.
7]Management of complications.
Diabetes is associated with a significant increase in the risk complications during pregnancy and delivery. Appropriate management, including medical education, therapy accurate insulin regiment and cautious obstetric management achieves a successful pregnancy outcome for the mother and child.
Gestational Diabetes Mellitus in Pregnant Women
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