Diabetes is the second commonest medical disorder complicating pregnancy.With the increase of maternal age due to socioeconomic reasons the incidence of diabetes mellitus in pregnancy is in the rise.Adverse effects of diabetes mellitus in pregnancy could be well controlled or prevented with early diagnosis and tight glycaemic control.
Effects on General Medical Status:
In established diabetics pre-existing complications such as retinopathy, nephropathy and vasculopathy will progress rapidly. But the pregnancy will not affect the long term outcome of these complications.
Due to the immuno-compromised state in pregnancy, diabetes will result in recurrent infections of respiratory, urinary and genital tracts.
Effects On Pregnancy:
Increased risk of abortions/miscarriage either in the first trimester or in the second trimester and increased risk of hyperemisis gravidarum.Polyhydramnios mainly due to fetal polyuria resulted by fetal hyperglycemia and also contributed by large placenta in diabetes and osmotic effect. Diabetic mothers have higher chances of developing pregnancy induced hypertension, prematurity and antepartum hemorrhage.
Effects On the Fetus:
In pre-existing uncontrolled diabetes the risk of congenital anomalies are three times high. Cardiac problems and neural tube defects are the common lesions to be seen but sacral agenesis, though rare is characteristic of diabetes mellitus.Hyperglycemia will result in pancreatic islet cell hyperplasia and high fetal insulin levels. This causes excessive anabolism in the fetus and results in fetal macrosomia.
Mothers with longstanding uncontrolled diabetes mellitus can have widespread vasculopathy including placental vessels. This will leads to poor placental perfusion and intra uterine growth restriction(IUGR).
Sudden intra uterine deaths (IUD) can occur in diabetic mothers.Relative placental insufficiency (for a large baby) sudden maternal hyperglycemia and hypoglycemia, lactic acidosis and diabetic cardiomyopathy of the fetus are some causes leading uterine deaths.
During Labour:
Effects on labour are mainly the results of either fetal macrosomia or polyhydramnios. Prolonged labour, perineal injuries, post partum hemorrhage and operative interferences can occur in diabetics. Shoulder dystocia is a well recognised complication of diabetic baby.
Puerperium:
Puerperal sepsis and failure of lactation are seen in diabetics.
Effects on the Neonate:
Birth injuries, respiratory distress due to poor surfactant production are seen at the time of birth. After clamping the code the glucose supply to the fetus is interrupted where as the insulin production continues. this results in fetal hypoglycemia. There is bone marrow hyperstimulaton in the fetus and at birth baby is plethoric and later baby will develop jaundice. Hypercoagulability leads to thrombosis of the gut resulting in necrotising enterocolitis and electrolyte imbalance.
Long term Complications:
Effects on General Medical Status:
In established diabetics pre-existing complications such as retinopathy, nephropathy and vasculopathy will progress rapidly. But the pregnancy will not affect the long term outcome of these complications.
Due to the immuno-compromised state in pregnancy, diabetes will result in recurrent infections of respiratory, urinary and genital tracts.
Effects On Pregnancy:
Increased risk of abortions/miscarriage either in the first trimester or in the second trimester and increased risk of hyperemisis gravidarum.Polyhydramnios mainly due to fetal polyuria resulted by fetal hyperglycemia and also contributed by large placenta in diabetes and osmotic effect. Diabetic mothers have higher chances of developing pregnancy induced hypertension, prematurity and antepartum hemorrhage.
Effects On the Fetus:
In pre-existing uncontrolled diabetes the risk of congenital anomalies are three times high. Cardiac problems and neural tube defects are the common lesions to be seen but sacral agenesis, though rare is characteristic of diabetes mellitus.Hyperglycemia will result in pancreatic islet cell hyperplasia and high fetal insulin levels. This causes excessive anabolism in the fetus and results in fetal macrosomia.
Mothers with longstanding uncontrolled diabetes mellitus can have widespread vasculopathy including placental vessels. This will leads to poor placental perfusion and intra uterine growth restriction(IUGR).
Sudden intra uterine deaths (IUD) can occur in diabetic mothers.Relative placental insufficiency (for a large baby) sudden maternal hyperglycemia and hypoglycemia, lactic acidosis and diabetic cardiomyopathy of the fetus are some causes leading uterine deaths.
During Labour:
Effects on labour are mainly the results of either fetal macrosomia or polyhydramnios. Prolonged labour, perineal injuries, post partum hemorrhage and operative interferences can occur in diabetics. Shoulder dystocia is a well recognised complication of diabetic baby.
Puerperium:
Puerperal sepsis and failure of lactation are seen in diabetics.
Effects on the Neonate:
Birth injuries, respiratory distress due to poor surfactant production are seen at the time of birth. After clamping the code the glucose supply to the fetus is interrupted where as the insulin production continues. this results in fetal hypoglycemia. There is bone marrow hyperstimulaton in the fetus and at birth baby is plethoric and later baby will develop jaundice. Hypercoagulability leads to thrombosis of the gut resulting in necrotising enterocolitis and electrolyte imbalance.
Long term Complications:
- Gestational diabetes mellitus in the future pregnancies.
- Diabetes mellitus in later life of the mother.
- Diabetes mellitus in later life of the baby.
