Skip to main content
Postgraduate Medical Journal logoLink to Postgraduate Medical Journal
. 1996 Sep;72(851):525–531. doi: 10.1136/pgmj.72.851.525

The management of diabetes in pregnancy.

D R Hadden 1
PMCID: PMC2398560  PMID: 8949587

Abstract

The aim of the diabetes specialist is to provide a service to the pregnant diabetic woman so that she will present to her obstetrician with such well-controlled plasma glucose levels that her pregnancy will proceed without any diabetes-related problem, and she will be delivered of a normal baby, of normal size, at the normal full-term gestation, by the normal route. There are some problems in achieving this aim. The exact definition of hyperglycaemia in pregnancy is still a matter of dispute. Screening methods to identify the problem differ widely. Many centres have developed joint diabetes/antenatal clinics, but there are practical problems with such an approach. Pre-pregnancy counselling, and discussion of contraceptive measures is an important task for the diabetologist and requires up-to-date knowledge. Control of plasma glucose requires alteration of insulin doses as pregnancy proceeds. Mothers with retinal, renal or cardiac problems will need special care. The medical problems which develop, and the management of blood glucose during labour and delivery, mean that the diabetes team must be very adjacent to the obstetric service, and a centralised approach offers many advantages. The postpartum state, and the long-term outcome for both mother and baby, remain both an interest and a responsibility for the obstetric physician.

Full text

PDF
525

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson A. S., Lean M. E., Pearson D. W., Sutherland H. W. A comparison between the diets of pregnant diabetic women and pregnant non-diabetic women. Diabet Med. 1990 Jun;7(5):452–456. doi: 10.1111/j.1464-5491.1990.tb01422.x. [DOI] [PubMed] [Google Scholar]
  2. Carpenter M. W., Coustan D. R. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol. 1982 Dec 1;144(7):768–773. doi: 10.1016/0002-9378(82)90349-0. [DOI] [PubMed] [Google Scholar]
  3. Fuhrmann K., Reiher H., Semmler K., Fischer F., Fischer M., Glöckner E. Prevention of congenital malformations in infants of insulin-dependent diabetic mothers. Diabetes Care. 1983 May-Jun;6(3):219–223. doi: 10.2337/diacare.6.3.219. [DOI] [PubMed] [Google Scholar]
  4. Hadden D. R. Geographic, ethnic, and racial variations in the incidence of gestational diabetes mellitus. Diabetes. 1985 Jun;34 (Suppl 2):8–12. doi: 10.2337/diab.34.2.s8. [DOI] [PubMed] [Google Scholar]
  5. Kimmerle R., Zass R. P., Cupisti S., Somville T., Bender R., Pawlowski B., Berger M. Pregnancies in women with diabetic nephropathy: long-term outcome for mother and child. Diabetologia. 1995 Feb;38(2):227–235. [PubMed] [Google Scholar]
  6. Klein B. E., Moss S. E., Klein R. Effect of pregnancy on progression of diabetic retinopathy. Diabetes Care. 1990 Jan;13(1):34–40. doi: 10.2337/diacare.13.1.34. [DOI] [PubMed] [Google Scholar]
  7. Langer O., Mazze R. The relationship between large-for-gestational-age infants and glycemic control in women with gestational diabetes. Am J Obstet Gynecol. 1988 Dec;159(6):1478–1483. doi: 10.1016/0002-9378(88)90578-9. [DOI] [PubMed] [Google Scholar]
  8. Martin R. A., Jones K. L., Mendoza A., Barr M., Jr, Benirschke K. Effect of ACE inhibition on the fetal kidney: decreased renal blood flow. Teratology. 1992 Oct;46(4):317–321. doi: 10.1002/tera.1420460402. [DOI] [PubMed] [Google Scholar]
  9. McBride M. O., Smye M., Nesbitt G. S., Hadden D. R. Bedside blood ketone body monitoring. Diabet Med. 1991 Aug-Sep;8(7):688–690. doi: 10.1111/j.1464-5491.1991.tb01679.x. [DOI] [PubMed] [Google Scholar]
  10. McCance D. R., Traub A. I., Harley J. M., Hadden D. R., Kennedy L. Urinary albumin excretion in diabetic pregnancy. Diabetologia. 1989 Apr;32(4):236–239. doi: 10.1007/BF00285290. [DOI] [PubMed] [Google Scholar]
  11. Nelson-Piercy C., Gale E. A. Do we know how to screen for gestational diabetes? Current practice in one regional health authority. Diabet Med. 1994 Jun;11(5):493–498. doi: 10.1111/j.1464-5491.1994.tb00313.x. [DOI] [PubMed] [Google Scholar]
  12. O'SULLIVAN J. B., MAHAN C. M. CRITERIA FOR THE ORAL GLUCOSE TOLERANCE TEST IN PREGNANCY. Diabetes. 1964 May-Jun;13:278–285. [PubMed] [Google Scholar]
  13. Pedersen J., Pedersen L. M. Prognosis of the outcome of pregnancies in diabetics. A new classification. Acta Endocrinol (Copenh) 1965 Sep;50(1):70–78. doi: 10.1530/acta.0.0500070. [DOI] [PubMed] [Google Scholar]
  14. Price J. H., Hadden D. R., Archer D. B., Harley J. M. Diabetic retinopathy in pregnancy. Br J Obstet Gynaecol. 1984 Jan;91(1):11–17. doi: 10.1111/j.1471-0528.1984.tb05272.x. [DOI] [PubMed] [Google Scholar]
  15. Small M., Cassidy L., Leiper J. M., Paterson K. R., Lunan C. B., MacCuish A. C. Outcome of pregnancy in insulin-dependent (type 1) diabetic women between 1971 and 1984. Q J Med. 1986 Dec;61(236):1159–1169. [PubMed] [Google Scholar]
  16. Steel J. M., Johnstone F. D., Smith A. F., Duncan L. J. Five years' experience of a "prepregnancy" clinic for insulin-dependent diabetics. Br Med J (Clin Res Ed) 1982 Jul 31;285(6338):353–356. doi: 10.1136/bmj.285.6338.353. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Traub A. I., Harley J. M., Cooper T. K., Maguiness S., Hadden D. R. Is centralized hospital care necessary for all insulin-dependent pregnant diabetics? Br J Obstet Gynaecol. 1987 Oct;94(10):957–962. doi: 10.1111/j.1471-0528.1987.tb02269.x. [DOI] [PubMed] [Google Scholar]

Articles from Postgraduate Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES