Pregnancy and Diabetes Management: Advances and Controversies

Abstract

BACKGROUND:The treatment of diabetes in pregnancy has potentially far-reaching benefits for both pregnant women with diabetes and their children and may provide a cost-effective approach to the prevention of obesity, type 2 diabetes mellitus, and metabolic syndrome. Early and accurate diagnosis of diabetes in pregnancy is necessary for optimizing maternal and fetal outcomes.CONTENT: Optimal control of diabetes in pregnancy requires achieving normoglycemia at all stages of a woman's pregnancy, including preconception and the postpartum period. In this review we focus on new universal guidelines for the screening and diagnosis of diabetes in pregnancy, including the 75-g oral glucose tolerance test, as well as the controversy surrounding the guidelines. We review the best diagnostic and treatment strategies for the pregestational and intrapartum periods, labor and delivery, and the postpartum period, and discuss management algorithms as well as the safety and efficacy of diabetic medications for use in pregnancy.

DNA Damage and Its Cellular Response in Mother and Fetus Exposed to Hyperglycemic Environment

“…During the last decade, there was an increased interest in the use of oral antihyperglycemic agents as an alternative to insulin in achieving good glycemic control. However, the results are inconclusive [79, 80]. …”

Efficacy and safety of insulin glulisine in the treatment of gestational diabetes

“…1 Gestational diabetes is akin to a pre-diabetic state, and affects both maternal and fetal morbidity and mortality. 2 Gestational diabetes affects 2% to 10% of pregnancies. 2 In the post-partum period, 5% to 10% of women with gestational diabetes are found to have diabetes, usually type 2.…”

“…2 Gestational diabetes affects 2% to 10% of pregnancies. 2 In the post-partum period, 5% to 10% of women with gestational diabetes are found to have diabetes, usually type 2. Among those women who have had gestational diabetes not determined to be type 1 or 2 postpartum, there is a 35% to 60% chance of developing type 2 diabetes in the next 10-20 years.…”

“…There are multiple reasons why most experts in gestational diabetes prefer insulin analogs over oral hypoglycemic agents; the most significant reason is that no oral agent will effectively treat postprandial hyperglycemia-the main driver of macrosomia. 2 To date, only two rapid-acting insulin analogs have been shown to be safe and effective for the treatment of diabetes during pregnancy: insulin aspart and insulin lispro. 6 Jovanovic and colleagues studied the metabolic and immunologic effects of insulin lispro in gestational diabetes by randomizing women to receive either regular human insulin or insulin lispro before consuming a test meal.…”

Implementation of new recommendations for the diagnosis of gestational diabetes: a 5-month audit

“…Results of the study are summarized in Table 2 . An optimal detection of any level of hyperglycemia in pregnancy is justifi ed not only by the continuous graded relationship between higher maternal plasma glucose and increasing risk of adverse pregnancy outcomes (3) , but also by the increasing prevalence of pre-gestational diabetes, which in pregnancies is associated with signifi cant risk of adverse perinatal outcome and also to deleterious long-term effects in infants of these diabetic mothers (5,6) . Furthermore, women with GD have an increased risk of developing type 2 diabetes compared with those with normoglycemic pregnancy, a history of GD therefore providing a natural screening test for future type 2 diabetes (7) .…”