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Management of Diabetes Mellitus (DM) During Pregnancy
Atul Goel (Associate Professor)*
Alka Goel (Doctor)**
Department of Medicine, Lady Hardinge Medical College*, and Safdarjang Hospital**, New Delhi, India
Summary
- Pre-existing DM complicates about 0.2-0.5% of all pregnancies; a further 1-3% of expectant mothers develop gestational diabetes.
- Diabetic pregnancy remains a high-risk state, with rates of maternal and neonatal mortality still 10-fold higher than in the general (non-diabetic) population.
- Fasting hypoglycaemia and post-prandial hyperglycaemia associated with pregnancy necessitate the adoption of different values for diagnosing diabetes during pregnancy.
- Pre-conception planning and counselling are essential in prospective mothers with diabetes; those taking oral hypoglycaemic agents should be shifted to insulin at least 6-8 weeks before the planned pregnancy.
- Managing diabetes requires a team approach involving the physician, obstetrician, dietitian, and nurse educator. The patient herself plays a pivotal part.
Editor's Comment
Pregnancy in diabetes is associated with an increase in risk to both the mother and foetus. The obstetrician and endocrinologist must therefore balance preserving the pregnancy with concomitant strict diabetes control. The current guidelines for managing diabetic pregnancy are elucidated in this article.
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