Skip to main content
Journal of the National Medical Association logoLink to Journal of the National Medical Association
. 1993 Jul;85(7):537–545.

Diabetes-related complications of pregnancy.

E A Reece 1, C J Homko 1
PMCID: PMC2568145  PMID: 8350376

Abstract

Diabetes mellitus is a major medical complication of pregnancy and is associated with an increased risk of maternal and perinatal morbidity and mortality. Although recent advances have improved outcomes dramatically, the increased incidence of congenital malformations remains a significant problem. In the past, it was believed that pregnancy worsened microvascular complications, and women with vasculopathy were counseled to avoid or terminate pregnancies. Recent evidence suggests that normalization of blood glucose levels and current management strategies can lead to improved outcomes even in women with vasculopathy. Today, with the exception of coronary artery disease, women with diabetes may be counseled toward a more favorable outcome. This article discusses preconception planning and contemporary treatment methods.

Full text

PDF
537

Selected References

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

  1. Ackrill P., Goodwin F. J., Marsh F. P., Stratton D., Wagman H. Successful pregnancy in patient on regular dialysis. Br Med J. 1975 Apr 26;2(5964):172–174. doi: 10.1136/bmj.2.5964.172. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. BROCK H. J., RUSSELL N. G., RANDALL C. L. Myocardial infarction in pregnancy; report of a case with normal spontaneous delivery seven months later. J Am Med Assoc. 1953 Jul 11;152(11):1030–1031. doi: 10.1001/jama.1953.63690110003011a. [DOI] [PubMed] [Google Scholar]
  3. Chestnut D. H., Zlatnik F. J., Pitkin R. M., Varner M. W. Pregnancy in a patient with a history of myocardial infarction and coronary artery bypass grafting. Am J Obstet Gynecol. 1986 Aug;155(2):372–373. doi: 10.1016/0002-9378(86)90830-6. [DOI] [PubMed] [Google Scholar]
  4. Coustan D. R., Reece E. A., Sherwin R. S., Rudolf M. C., Bates S. E., Sockin S. M., Holford T., Tamborlane W. V. A randomized clinical trial of the insulin pump vs intensive conventional therapy in diabetic pregnancies. JAMA. 1986 Feb 7;255(5):631–636. [PubMed] [Google Scholar]
  5. Delaney J. J., Ptacek J. Three decades of experience with diabetic pregnancies. Am J Obstet Gynecol. 1970 Feb 15;106(4):550–556. doi: 10.1016/0002-9378(70)90040-2. [DOI] [PubMed] [Google Scholar]
  6. 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]
  7. Goldman J. A., Dicker D., Feldberg D., Yeshaya A., Samuel N., Karp M. Pregnancy outcome in patients with insulin-dependent diabetes mellitus with preconceptional diabetic control: a comparative study. Am J Obstet Gynecol. 1986 Aug;155(2):293–297. doi: 10.1016/0002-9378(86)90812-4. [DOI] [PubMed] [Google Scholar]
  8. Hare J. W., White P. Pregnancy in diabetes complicated by vascular disease. Diabetes. 1977 Oct;26(10):953–955. [PubMed] [Google Scholar]
  9. Hibbard L. T. Maternal mortality due to cardiac disease. Clin Obstet Gynecol. 1975 Sep;18(3):27–36. doi: 10.1097/00003081-197509000-00005. [DOI] [PubMed] [Google Scholar]
  10. Jovanovic L., Druzin M., Peterson C. M. Effect of euglycemia on the outcome of pregnancy in insulin-dependent diabetic women as compared with normal control subjects. Am J Med. 1981 Dec;71(6):921–927. doi: 10.1016/0002-9343(81)90301-6. [DOI] [PubMed] [Google Scholar]
  11. Jovanovic L., Druzin M., Peterson C. M. Effect of euglycemia on the outcome of pregnancy in insulin-dependent diabetic women as compared with normal control subjects. Am J Med. 1981 Dec;71(6):921–927. doi: 10.1016/0002-9343(81)90301-6. [DOI] [PubMed] [Google Scholar]
  12. Jovanovic R., Jovanovic L. Obstetric management when normoglycemia is maintained in diabetic pregnant women with vascular compromise. Am J Obstet Gynecol. 1984 Jul 15;149(6):617–623. doi: 10.1016/0002-9378(84)90245-x. [DOI] [PubMed] [Google Scholar]
  13. Karlsson K., Kjellmer I. The outcome of diabetic pregnancies in relation to the mother's blood sugar level. Am J Obstet Gynecol. 1972 Jan 15;112(2):213–220. doi: 10.1016/0002-9378(72)90118-4. [DOI] [PubMed] [Google Scholar]
  14. Kitzmiller J. L., Brown E. R., Phillippe M., Stark A. R., Acker D., Kaldany A., Singh S., Hare J. W. Diabetic nephropathy and perinatal outcome. Am J Obstet Gynecol. 1981 Dec 1;141(7):741–751. doi: 10.1016/0002-9378(81)90698-0. [DOI] [PubMed] [Google Scholar]
  15. 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]
  16. Macleod A. F., Smith S. A., Sönksen P. H., Lowy C. The problem of autonomic neuropathy in diabetic pregnancy. Diabet Med. 1990 Jan;7(1):80–82. doi: 10.1111/j.1464-5491.1990.tb01313.x. [DOI] [PubMed] [Google Scholar]
  17. Mills J. L., Knopp R. H., Simpson J. L., Jovanovic-Peterson L., Metzger B. E., Holmes L. B., Aarons J. H., Brown Z., Reed G. F., Bieber F. R. Lack of relation of increased malformation rates in infants of diabetic mothers to glycemic control during organogenesis. N Engl J Med. 1988 Mar 17;318(11):671–676. doi: 10.1056/NEJM198803173181104. [DOI] [PubMed] [Google Scholar]
  18. Nelson L. H., Meis P. J., Hatjis C. G., Ernest J. M., Dillard R., Schey H. M. Premature rupture of membranes: a prospective, randomized evaluation of steroids, latent phase, and expectant management. Obstet Gynecol. 1985 Jul;66(1):55–58. [PubMed] [Google Scholar]
  19. Reece E. A., Coustan D. R., Hayslett J. P., Holford T., Coulehan J., O'Connor T. Z., Hobbins J. C. Diabetic nephropathy: pregnancy performance and fetomaternal outcome. Am J Obstet Gynecol. 1988 Jul;159(1):56–66. doi: 10.1016/0002-9378(88)90494-2. [DOI] [PubMed] [Google Scholar]
  20. Reece E. A., Egan J. F., Coustan D. R., Tamborlane W., Bates S. E., O'Neill T. M., Fitzpatrick J. G. Coronary artery disease in diabetic pregnancies. Am J Obstet Gynecol. 1986 Jan;154(1):150–151. doi: 10.1016/0002-9378(86)90414-x. [DOI] [PubMed] [Google Scholar]
  21. Reece E. A., Hobbins J. C. Diabetic embryopathy: pathogenesis, prenatal diagnosis and prevention. Obstet Gynecol Surv. 1986 Jun;41(6):325–335. [PubMed] [Google Scholar]
  22. Roversi G. D., Gargiulo M., Nicolini U., Pedretti E., Marini A., Barbarani V., Peneff P. A new approach to the treatment of diabetic pregnant women. Report of 479 cases seen from 1963 to 1975. Am J Obstet Gynecol. 1979 Nov 1;135(5):567–576. doi: 10.1016/s0002-9378(16)32978-7. [DOI] [PubMed] [Google Scholar]
  23. SIEGLER A. M., HOFFMAN J., BLOOM O. Myocardial infarction complicating pregnancy. Obstet Gynecol. 1956 Mar;7(3):306–311. [PubMed] [Google Scholar]
  24. Scott A. R., Tattersall R. B., McPherson M. Improvement of postural hypotension and severe diabetic autonomic neuropathy during pregnancy. Diabetes Care. 1988 Apr;11(4):369–370. doi: 10.2337/diacare.11.4.369. [DOI] [PubMed] [Google Scholar]
  25. Serup L. Influence of pregnancy on diabetic retinopathy. Acta Endocrinol Suppl (Copenh) 1986;277:122–124. doi: 10.1530/acta.0.111s0122. [DOI] [PubMed] [Google Scholar]
  26. Silfen S. L., Wapner R. J., Gabbe S. G. Maternal outcome in class H diabetes mellitus. Obstet Gynecol. 1980 Jun;55(6):749–751. [PubMed] [Google Scholar]
  27. Sinclair S. H., Nesler C. L., Schwartz S. S. Retinopathy in the pregnant diabetic. Clin Obstet Gynecol. 1985 Sep;28(3):536–552. doi: 10.1097/00003081-198528030-00009. [DOI] [PubMed] [Google Scholar]
  28. Steel J. M. Autonomic neuropathy in pregnancy. Diabetes Care. 1989 Feb;12(2):170–171. doi: 10.2337/diacare.12.2.170. [DOI] [PubMed] [Google Scholar]
  29. Tydén G., Brattström C., Björkman U., Landgraf R., Baltzer J., Hillebrand G., Land W., Calne R., Brons I. G., Squifflet J. P. Pregnancy after combined pancreas-kidney transplantation. Diabetes. 1989 Jan;38 (Suppl 1):43–45. doi: 10.2337/diab.38.1.s43. [DOI] [PubMed] [Google Scholar]
  30. White P. Diabetes mellitus in pregnancy. Clin Perinatol. 1974 Sep;1(2):331–347. [PubMed] [Google Scholar]
  31. White P. Life cycle of diabetes in youth. 50th anniversary of the discovery of insulin (1921-1971). J Am Med Womens Assoc. 1972 Jun;27(6):293–passim. [PubMed] [Google Scholar]

Articles from Journal of the National Medical Association are provided here courtesy of National Medical Association

RESOURCES