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Diabetes and Pregnancy

  • Alyce M. Thomas
Chapter
Part of the Nutrition and Health book series (NH)

Abstract

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 (gestational diabetes mellitus); the other 10% preceded the pregnancy. Since the discovery of insulin, perinatal mortality rates for women with diabetes have decreased, however, infant morbidity remains higher than in the non-diabetes pregnant population.

Diabetes is classified as type 1 diabetes, type 2 diabetes, and gestational diabetes mellitus (GDM). Type 1 diabetes is characterized by absolute insulin deficiency caused by autoimmune destruction of the pancreatic beta-cells. Type 2 diabetes is associated with insulin resistance, obesity, and relative insulin deficiency. Gestational diabetes mellitus is defined as diabetes that is first diagnosed in the second or third trimester of pregnancy that is not clearly either preexisting type 1 or type 2 diabetes. The risk for maternal and fetal complications decreases if optimal blood glucose control is achieved and maintained prior to and during pregnancy. This emphasizes the importance of preconception counseling incorporated into the care of women with preexisting diabetes during their childbearing years.

Self-management is the key to reducing the risks associated with diabetes and pregnancy. For women with preexisting diabetes, this includes medical nutrition therapy, insulin therapy, sick-day rule procedures, self-monitoring of blood glucose and if necessary, ketones, and physical activity. Current nutrition recommendations for persons with diabetes may be used for pregnant women with type 1 diabetes and type 2 diabetes. Most women with gestational diabetes are able to control their blood glucose levels through lifestyle interventions, which includes medical nutrition therapy and physical activity. Occasionally, pharmacological therapy may be necessary as an adjunct to normalize blood glucose control.

Breastfeeding is not a contraindication of diabetes and should be encouraged in women with preexisting diabetes. Women with previous gestational diabetes are at risk of developing this condition in subsequent pregnancies and type 2 diabetes later in life. The risk is decreased if healthy lifestyles are adopted after pregnancy.

Keywords

Preexisting diabetes Gestational diabetes mellitus Congenital anomaly Insulin resistance Insulin sensitivity Normoglycemia 

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologySt. Joseph’s University Medical CenterPatersonUSA

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