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High Risk Pregnancy

Anemia in Pregnancy
Diabetes in Pregnancy
Hypertension in pregnancy
Cardiac disease in pregnancy
Liver disease in pregnancy
Malaria in Pregnancy
HIV infection in pregnancy
Recurrent Abortion
Pregnancy and Renal Disease
Hematological Problems in Pregnancy
Hemoglobinopathies in Pregnancy
Thrombophilia in Pregnancy
 
 

Diabetes in Pregnancy

 
Diabetes can lead to a number of problems in pregnancy and must be carefully controlled throughout. It may be diagnosed for the first time during pregnancy or may arise because of pregnancy. Babies of diabetic women are usually delivered a little early to overcome any problems.
 
Effects of Diabetes on Pregnancy
  • Need for pregnancy planning
  • Risk of congenital malformations, miscarriage, macrosomia, IUD, polyhydramnios (5-26%), preterm labor (3 fold increase), birth injuries, pre-eclampsia, infection and increased caesarean section rate
  • Need for regular clinical, biochemical and ultrasound monitoring.
 
Counselling

Pre pregnancy counselling is the cornerstone of management. It allows early detection, assessment of severity and treatment of medical complications, control of hypertension, laser therapy for proliferative retinopathy, to switch to insulin and to stop oral hypoglycemic agents (OHA), and optimization of glycemic control (HbAlC < 6.5%) at least 6 months before contemplating pregnancy.

 
 
Medical Management
Diet and Exercise

This is the main stay of treatment. Carbohydrates with a low glycemic index like bran (resulting in sustained slow release of glucose) are advised.
The ADA recommends that normal weight women consume 30-32 Kcal/kg in the second half of pregnancy.

 
Insulin
Persistent postprandial hyperglycemia (>7.5-8.0 mmol/1) or fasting hyperglycemia (> 6.0 mmol/L) despite compliance with diet is an indication for introduction of insulin therapy. It is usually given as short acting insulin before meals, although in more severe cases intermediate acting insulin at night may be added.
 
OHA
  • Glyburide: This sulphonylurea enhances insulin secretions and does not significantly cross the placenta. It serves as a suitable alternative to insulin for the treatment of GDM with similar perinatal outcomes.
    However, it should not be used in the first trimester and has the disadvantage that it sometimes takes more than one week to observe the effects of dose titrations,
  • Metformin: In women with PCOS, metformin may be safe and may reduce the risk of miscarriage and the development of GDM when used for the entire pregnancy.
 
Prevention

Loss of weight prior to pregnancy following appropriate diet and life style modifications and regular exercise result in reduction in the risk of development of type 2 diabetes mellitus, and gestational diabetes mellitus in some patients but not in very susceptible individuals.

 
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