| 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. |
