Diabetes in pregnancy is classified into two types- Overt Diabetes which is seen in women who are diabetic even before the onset of pregnancy and Gestational Diabetes in which diabetes is detected in the course of pregnancy.
The insulin requirements during pregnancy increases alot because of very large increase in insulin antagonising hormones like Human placental lactogen, progesterone and cortisol. It is also increased because of the production enzymes like placental insulinase by the placenta which increases the degradation of insulin. The patient should be watched carefully otherwise it may lead to ketosis. Good medical and obstetric care throughout pregnancy results in favourable outcome. However the following complications may occur.
There is an increased risk of abortion among patients with uncontrollable diabetes. Fetal malformations and preterm delivery is a risk factor among overt diabetics. Moreover diabetic women may develop pregnancy induced hypertension and urinary tract infection. There is a chance of developing Hydramnios among uncontrollable diabetic women which may be due to large placenta, fetal malformation, etc.
Gestational diabetes can be diognised by undergoing screening test for diabetes which should be performed between 24 and 28 weeks of pregnancy. If the test is found to be positive then they should undergo Glucose Tolerance Test. Risk factors for screening for gestational diabetes include- Maternal obesity (120% increase in the body weight when compared to ideal weight), previous large baby (above 4kh), previous unexplained still births, previous abnormal glucose tolerance test, Hydramnios or macrosomia in the present pregnancy.
Because of the risk of sudden intra-uterine death in the third trimester, diabetic women have traditionally been delivered at 36-38 weeks either by caesarian section or by vaginal delivery following induction. Today improved metabolic control makes later delivery possible and most are now delivered between 38 and 39 weeks gestation.
NOTE- Good antenatal care and intervetion at the appropriate time will improve the outcome.
Prenatal counselling and proper guidance will decrease the incidence of fetal malformations and fetal loss.
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