An Update on Diabetic Women Obstetrical Outcomes Linked to Preconception and Pregnancy Glycemic Profile: A Systematic Literature Review

Salvatore Gizzo,Marta Rossanese,Marco Noventa,Roberto Berretta,Michele Gangemi,Stefania Di Gangi,Tito Silvio Patrelli,Giovanni Battista Nardelli,Martina Bertin

doi:10.1155/2013/254901

Salvatore Gizzo, Marta Rossanese + Show 7 more

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https://doi.org/10.1155/2013/254901

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Abstract

Women with type 2 diabetes were less likely to have diabetes related complications than women with type 1. Women with type 1 diabetes had a high prepregnancy care and showed a worse glycemic control than women with type 2 both in the preconception period and during pregnancy. Obstetrical outcomes showed that preeclampsia and stillbirth rate is almost doubled in type 1 patients while perinatal deaths and SGA importantly increased in type 2 diabetes. In modern obstetrical care it is mandatory to maintain glucose levels as close to normal as possible particularly in diabetic population. HbA1C no higher than 6% before pregnancy and during the first trimester seems to decrease the risk of adverse obstetrical outcomes. Both the preconceptional counseling and glycemic profile optimization represent a fundamental step to improve pregnancy outcomes in women with preexisting diabetes. A systematic approach to family planning and the availability of preconception care for all diabetic women who desire pregnancy could be an essential step for diabetic management program.

Highlights

IntroductionDiabetes is a metabolic disease determined by defects in insulin secretion, insulin action, or both, which caused a chronic hyperglycemia with a long-term damage, dysfunction, and failure of different organs
Obstetrical outcomes showed that preeclampsia and stillbirth rate is almost doubled in type 1 patients while perinatal deaths and small for gestational age (SGA) importantly increased in type 2 diabetes
Diabetes is a metabolic disease determined by defects in insulin secretion, insulin action, or both, which caused a chronic hyperglycemia with a long-term damage, dysfunction, and failure of different organs

Summary

Introduction

Diabetes is a metabolic disease determined by defects in insulin secretion, insulin action, or both, which caused a chronic hyperglycemia with a long-term damage, dysfunction, and failure of different organs. According to the International Diabetes Federation (IDF) the worldwide prevalence of diabetes mellitus in 2011 resulted in 366 millionof cases and projections speculate that in 2030 the prevalence of this metabolic disease will reach 552 million of cases (estimated prevalence of about 7.7%) [2]. Pregnancy is physiologically characterized by increased insulin resistance and reduced sensitivity to insulin action, due to the effects of placental hormones, like human placental lactogen, progesterone, prolactin, placental growth hormone, and cortisol This change in maternal metabolism is directed towards supplying adequate nutrition for the fetus [4]

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