Diabetes and Pregnancy

Summary

Diabetes mellitus is the most common complication in pregnancy, affecting nearly 8% of all pregnancies. Nearly 90% of women with diabetes develop the condition during pregnancy; diabetes in the other 10% antedated the pregnancy. Since the discovery of insulin, perinatal mortality rates for women with diabetes have decreased, however, infant morbidity remains higher than in the nondiabetes pregnant population.

Diabetes in pregnancy can be classified as type 1 diabetes, type 2 diabetes, and gestational diabetes mellitus (GDM). Type 1 diabetes is characterized by insulin deficiency caused by autoimmune destruction of the pancreatic beta-cells. Type 2 diabetes is associated with insulin resistance and obesity rather than insulin deficiency. GDM is defined as glucose intolerance with onset or first recognition during pregnancy.

The risk for maternal and fetal complications decreases if the woman is in optimal blood glucose control during pregnancy. Women with preexisting diabetes should receive preconceptional counseling during their childbearing years to achieve and maintain glycemic control and to address medical conditions that could affect the pregnancy.

Self-management is the key to reducing the risks associated with diabetes and pregnancy. For women with preexisting diabetes, these include medical nutrition therapy (MNT), insulin therapy, self-monitoring of blood glucose and ketones, and physical activity. Current nutrition recommendations for the treatment of diabetes may be used for pregnant women with type 1 diabetes and type 2 diabetes. MNT is the cornerstone of treatment for women with GDM. Most women with GDM can control their blood glucose by following a carbohydrate modified meal plan that also provides sufficient energy and nutrients to promote maternal and fetal health. Occasionally, medication may be added to maintain optimal blood glucose control.

Breastfeeding is not contraindicated in GDM and should be encouraged. Women with GDM in a previous pregnancy are at risk of developing this condition in subsequent pregnancies and type 2 diabetes later in life. Women should be encouraged to develop healthy lifestyles to decrease their risk of developing diabetes-related conditions.