Diabetes mellitus and pregnancy

For pregnant women with diabetes, some particular challenges exist for both mother and child. If the woman has diabetes as an intercurrent disease in pregnancy, it can cause early labor, birth defects, and larger than average infants. For pregnant women with diabetes, some particular challenges exist for both mother and child. If the woman has diabetes as an intercurrent disease in pregnancy, it can cause early labor, birth defects, and larger than average infants. Planning in advance is emphasized if one wants to become pregnant and has type 1 diabetes mellitus or type 2 diabetes mellitus. Stringent blood glucose control is needed before pregnancy. During a normal pregnancy, many maternal physiological changes occur and there is an increase in insulin needs due to increased hormonal secretions that regulate blood glucose levels, glucose-'drain' to the fetus, slowed emptying of the stomach, increased excretion of glucose by the kidneys and resistance of cells to insulin. The risks of maternal diabetes to the developing fetus include miscarriage, growth restriction, growth acceleration, fetal obesity (macrosomia), mild neurological deficits, polyhydramnios and birth defects.In some studies 4% to 11% of infants born to type 1 diabetic women had defects compared to 1.2% to 2.1% of infants born in the general population. The cause is, e.g., oxidative stress, by activating protein kinase C that leads to apoptosis of some cells. A hyperglycemic maternal environment has also been associated with neonates that are at greater risk for development of negative health outcomes such as future obesity, insulin resistance, type 2 diabetes mellitus, and metabolic syndrome. During the first trimester, besides increased birth defect risks, having a miscarriage is also increased due to abnormal development in the early stages of pregnancy. When blood glucose is not controlled, shortly after birth, the infant's lungs may be under developed and can cause respiratory problems. Hypoglycemia can occur after birth if the mother's blood sugar was high close to the time of delivery, which causes the baby to produces extra insulin of its own. Mild neurological and cognitive deficits in offspring — including increased symptoms of ADHD, impaired fine and gross motor skills, and impaired explicit memory performance — have been linked to pregestational type 1 diabetes and gestational diabetes. Prenatal iron deficiency has been suggested as a possible mechanism for these problems. Birth defects are not currently an identified risk for the child of women with gestational diabetes, since those primarily occur in the latter part of pregnancy, where vital organs already have taken their most essential shape. High blood sugar levels are harmful to the mother and her fetus. Experts advise diabetics to maintain blood sugar level close to normal range for 2 to 3 months before planning for pregnancy. Managing blood sugar close to normal before and during pregnancy helps to protect the health of mother and the baby.