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Diabetes is the most common medical complication of pregnancy. Gestational diabetes mellitus is defined as glucose intolerance or diabetes diagnosed for the first time during pregnancy. Diabetes occurs in about 1-3% of all pregnancies. Ninety percent of these cases represent gestational diabetes mellitus (GDM).
Pathophysiology
Pregestational diabetes is present prior to pregnancy, and it is classified as either type 1 or type 2.
Gestational diabetes is glucose intolerance first recognized during pregnancy.
Complications of Diabetes in the Newborn. Macrosomia, hypocalcemia, hyperbilirubinemia, fetal hypoglycemia, respiratory distress, and congenital anomalies, such as caudal regression, spina bifida, anencephalus, and heart and renal anomalies.
Pregestational Diabetes
There is a fourfold increase in the incidence of major congenital malformations in the offspring of women with pregestational that is poorly controlled.
Pregnancy has been associated with a twofold risk for the progression of maternal diabetic retinopathy. Proliferative diabetes, retinopathy may lead to vision loss if untreated.
Diabetic women should be evaluated before pregnancy by means of a history, physical examination, ophthalmologic evaluation, and 24-hour urine collection for creatinine clearance and protein excretion. If this evaluation has not been accomplished before pregnancy, it should be done.