Diabetes mellitus and pregnancy 3049655 225922575 2008-07-16T01:03:07Z SieBot 4005189 robot Modifying: [[he:סוכרת בהיריון]] 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 [[childbirth|labor]], [[birth defect]]s, and very large babies. ==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 [[kidney]]s and resistance of [[cell (biology)|cell]]s to [[insulin]]. ==Risks for the child== [[Miscarriage]], growth restriction, growth acceleration, fetal obesity ([[macrosomia]]), [[polyhydramnios]] and [[birth defects]]. ===Birth defects=== Birth defects are not currently an identified risk for the child of women with [[gestational diabetes]], since this primarily occur in the latter part of pregnancy, where vital organs already have taken their most essential shape. Still, having [[diabetes type I]] or [[diabetes type II|II]] has a 2-3 <ref name=gareskog> [http://publications.uu.se/theses/spikblad.xsql?dbid=7203 Author: Gäreskog, Mattias Title: Teratogenicity Involved in Experimental Diabetic Pregnancy]</ref> fold increase in risk of birth defects. The cause is e.g. [[oxidative stress]], by activating [[protein kinase C]]<ref name=gareskog/> and lead to [[apoptosis]] of some cells<ref name=gareskog/>. ==Risks for the mother== Disturbed blood glucose levels. Hypoglycaemia can occur without warning. ==Classification== The White classification, named after [[Priscilla White (physician)|Priscilla White]]<ref name="PWhite">White P. Pregnancy complicating diabetes. ''Am J Med'' 1949; 7: 609. PMID 15396063</ref> 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 prior to pregnancy (pregestational diabetes). These two groups are further subdivided according to their associated risks and management.<ref name="OBSTETRICS">Gabbe S.G., Niebyl J.R., Simpson J.L. OBSTETRICS: Normal and Problem Pregnancies. Fourth edition. Churchill Livingstone, New York, 2002. ISBN 0-443-06572-1</ref> There are 2 classes of gestational diabetes (diabetes which began during pregnancy): * Class A<sub>1</sub>: gestational diabetes; diet controlled * Class A<sub>2</sub>: gestational diabetes; insulin controlled The second group of diabetes which existed prior to 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. ==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 drug]]s should be replaced with [[insulin]]. ==See also== * [[Diabetes mellitus]] * [[Gestational diabetes]] * [[Pregnancy]] ==Footnotes== {{reflist}} ==External links== *[http://www.cdc.gov/ncbddd/bd/diabetespregnancy.htm CDC’s National Center on Birth Defects and Developmental Disabilities] {{Pregnancy}} [[Category:Obstetrics]] [[Category:Diabetes]] [[Category:Pregnancy]] [[he:סוכרת בהיריון]]