Diabetes mellitus and pregnancy

Overview
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.

Physiology
During a normal pregnancy, a lot of 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.

Risks for the child
Miscarriage, growth restriction, growth acceleration, fetal obesity (macrosomia), polyhydramnios. Birth defects are not currently an identified risk for the child of women with gestational diabetes.

Risks for the mother
Disturbed blood glucose levels. Hypoglycaemia can occur without warning.

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.