Diabetes Mellitus in Pregnancy: Treatment Pregnancy complicated by diabetes mellitus is associated with higher maternal and perinatal morbidity and mortality rates. Preconception counseling and treatment are important for the diabetic patient contemplating pregnancy and can reduce the risk of congenital malformations and improve pregnancy outcome. Folate supplementation reduces the incidence of fetal neural tube defects, which occur with greater frequency in fetuses of diabetic mothers. In addition, optimizing glucose control during key periods of organogenesis reduces other congenital anomalies including sacral agenesis, caudal dysplasia, renal agenesis, and ventricular septal defect. Once pregnancy is established, glucose control should be managed more. | Chapter 007. Medical Disorders during Pregnancy Part 5 Diabetes Mellitus in Pregnancy Treatment Pregnancy complicated by diabetes mellitus is associated with higher maternal and perinatal morbidity and mortality rates. Preconception counseling and treatment are important for the diabetic patient contemplating pregnancy and can reduce the risk of congenital malformations and improve pregnancy outcome. Folate supplementation reduces the incidence of fetal neural tube defects which occur with greater frequency in fetuses of diabetic mothers. In addition optimizing glucose control during key periods of organogenesis reduces other congenital anomalies including sacral agenesis caudal dysplasia renal agenesis and ventricular septal defect. Once pregnancy is established glucose control should be managed more aggressively than in the nonpregnant state. In addition to dietary changes this requires more frequent blood glucose monitoring and often involves additional injections of insulin or conversion to an insulin pump. Fasting blood glucose levels should be maintained at mmol L 105 mg dL with no values mmol L 140 mg dL . Commencing in the third trimester regular surveillance of maternal glucose control as well as assessment of fetal growth obstetric sonography and fetoplacental oxygenation fetal heart rate monitoring or biophysical profile optimizes pregnancy outcome. Pregnant diabetic patients without vascular disease are at greater risk for delivering a macrosomic fetus and attention to fetal growth via clinical and ultrasound examinations is important. Fetal macrosomia is associated with an increased risk of maternal and fetal birth trauma. Pregnant women with diabetes have an increased risk of developing preeclampsia and those with vascular disease are at greater risk for developing intrauterine growth restriction which is associated with an increased risk of fetal and neonatal death. Excellent pregnancy outcomes in patients with diabetic nephropathy and .
