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Obstetric Care of the Woman with Diabetes

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Diabetes in Women

Part of the book series: Contemporary Diabetes ((CDI))

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Abstract

Diabetes increases the risk of complications during pregnancy. Starting in the preconception period and continuing throughout pregnancy and postpartum, heightened surveillance is necessary in order to achieve a healthy outcome for both mother and neonate. This chapter will outline the complications that may arise during pregnancies complicated by diabetes and suggest a management scheme for the gravid woman with diabetes.

Specific concerns in the first trimester include an increased risk of miscarriage and careful evaluation of the maternal risks specific to the patient’s cardiovascular, renal, thyroid, and ophthalmologic status. In the early second trimester, fetal testing for congenital birth defects and other diagnostic procedures are recommended. This trimester is complicated by increasing insulin requirements that usually continue into the third trimester. In late pregnancy, concern shifts to fetal size, preeclampsia, stillbirth, and deciding delivery timing and route.

Labor and delivery is a unique time for the gravid woman with diabetes, as there are specific challenges with changing insulin requirements related to labor, mode of delivery, and type of diabetes. This chapter will give a brief overview of the use of insulin during pregnancy, intrapartum as well as postpartum, but please refer to Chap. 17 for a more complete discussion. Postpartum concerns in women with diabetes include an increased risk of endometritis and wound infection, postpartum thyroiditis, decreased insulin requirements, and contraception challenges.

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Authors and Affiliations

  1. Dept. of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Joslin Diabetes in Pregnancy Program, Maternal-Fetal Medicine, Boston, MA, USA

    Tamara C. Takoudes M.D.

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  1. Tamara C. Takoudes M.D.
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Editors and Affiliations

  1. Dept. Medicine, University Ioannina, Ioannina, 455 10, Greece

    Agathocles Tsatsoulis

  2. Dept. Internal Medicine, University of Michigan, E. Medical Center Dr. 1500, Ann Arbor, 48109-0354, U.S.A.

    Jennifer Wyckoff

  3. Dept. Medicine, Harvard Medical School, Joslin Place 1, Boston, 02215, U.S.A.

    Florence M. Brown

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Takoudes, T.C. (2009). Obstetric Care of the Woman with Diabetes. In: Tsatsoulis, A., Wyckoff, J., Brown, F. (eds) Diabetes in Women. Contemporary Diabetes. Humana Press. https://doi.org/10.1007/978-1-60327-250-6_16

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