Diabetes mellitus Related articles
Types of diabetes
Prediabetes:    • Impaired fasting glycaemia    • Impaired glucose tolerance Diabetes mellitus type 1 Diabetes mellitus type 2 Gestational diabetes
Blood tests
Blood sugar Glycosylated hemoglobin Glucose tolerance test Fructosamine
Diabetes management
Diabetic diet Anti-diabetic drugs Insulin therapy Glossary of diabetes
Complications
Cardiovascular disease Diabetic comas:    • Diabetic hypoglycemia    • Diabetic ketoacidosis    • Nonketotic hyperosmolar Diabetic myonecrosis Diabetic nephropathy Diabetic neuropathy Diabetic retinopathy Diabetes and pregnancy

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

[edit] 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.

[edit] Risks for the child

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

[edit] Birth defects

Birth defects are not currently an identified risk for the child of women with gestational diabetes, since those 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].

[edit] Risks for the mother

Disturbed blood glucose levels. Hypoglycaemia can occur without warning.

[edit] 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 before 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 before 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.

[edit] 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.

[edit] See also

• Diabetes mellitus
• Gestational diabetes
• Pregnancy

[edit] Footnotes

[edit] External links

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

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