DIABETES MANAGEMENT PROGRAM
More than 8 million women in the United States have pregestational diabetes mellitus, and it is observed in 1% of all pregnancies. Although 90% of diabetes cases encountered during pregnancy are gestational diabetes mellitus (GDM), more than one half of these women eventually develop type 2 pregestational diabetes mellitus later in life.
Overall perinatal outcome is best when glucose control is achieved before conception and in the absence of maternal vascular disease.
What Problems are Associated with Diabetes Mellitus in Pregnancy?
Major congenital anomalies are the leading cause of perinatal mortality in pregnancies complicated by pregestational diabetes mellitus, occurring in 6-12% of infants of women with diabetes. Studies have linked the increased rate of congenital malformations, as well as spontaneous abortion, to poor preconceptional glucose control. Hyperglycemia during 5-8 weeks after the last menstrual period is thought to play a critical role in abnormal development. Glycosylated hemoglobin levels correlate directly with the frequency of anomalies. A level less than 1% higher than the upper limit of normal, or approximately 5-6%, is associated with a fetal malformation rate close to that observed in normal pregnancies (2-3%), whereas an Hb A1C concentration near 10% is associated with a fetal anomaly rate of 20-25%. Complex cardiac defects; central nervous system anomalies, such as anencephaly and spina bifida; and skeletal malformations, including sacral agenesis are most common.
Adverse perinatal outcomes later in pregnancy also are increased in women with pregestational diabetes mellitus. Excessive fetal growth may occur. The fetus of a woman with poorly controlled diabetes is at increased risk of intrauterine fetal death and is more likely to weigh more than 4,000 g with a disproportionate concentration of fat around the shoulders and chest, which more than doubles the risk of shoulder dystocia at vaginal delivery. The neonatal consequences of poorly controlled pre-gestational diabetes mellitus during pregnancy include profound hypoglycemia, a higher rate of respiratory distress syndrome, polycythemia, organomegaly, electrolyte disturbances, and hyperbilirubinemia.
Spontaneous preterm labor appears to be more common in women with pregestational diabetes mellitus. The increased incidence of polyhydramnios may be a cause of preterm labor in some patients with pregestational diabetes mellitus, particularly those with poor glycemic control. Preeclampsia is observed in 15–20% of pregnancies complicated by type 1 diabetes mellitus without nephropathy and approximately 50% in the presence of nephropathy. Preeclampsia also is more likely in women with hypertension and poor glucose control. In the setting of hypertension and nephropathy, the risk of fetal intrauterine growth restriction is more than doubled. The rate of primary cesarean delivery is increased in women with pregestational diabetes.
When a pregnant woman has high blood sugar (glucose) but has never had diabetes before, she is said to have gestational diabetes. Gestational diabetes mellitus has been characterized as carbohydrate intolerance that begins or is first recognized during pregnancy. This condition affects about four percent (4%) of all pregnant women, which translates to about 135,000 cases of gestational diabetes in the United States each year.
What Problems are Associated with Gestational Diabetes in Pregnancy?
Women with gestational diabetes are more likely to develop hypertensive disorders, such as preeclampsia. Also, women with gestational diabetes have an increased risk to have a cesarean delivery. In addition, women with gestational diabetes have an increased risk of developing diabetes later in life.
Babies of women with GDM are prone to such adverse events as macrosomia with its potential complications and hyperbilirubinemia. Babies of women with GDM are at increased risk for operative delivery, shoulder dystocia, and birth trauma.
A Healthy Pregnancy for Women With Diabetes (PDF)
Gestational Diabetes (PDF)
Diabetes Management Program
The program is designed for the patient who has diabetes prior to conception or for the patient who has developed diabetes at any stage of pregnancy
Our diabetes in pregnancy programs provide pregnant women with the skills necessary to control their diabetes to help ensure a healthy pregnancy with sweet success!
Prepregnancy consultation (before pregnancy)
Consultation during pregnancy
Education about diabetes mellitus and pregnancy
Education about gestational diabetes
Blood glucose monitoring
Nutritious meal planning
Healthy coping strategies
Fetal anatomic ultrasound and fetal echocardiogram
Serial fetal growth ultrasounds every 4 weeks
Testing your baby’s health with non stress tests (NSTs) or BPPs