Diabetic Emergencies in Pregnancy

Abstract

Diabetes in pregnancy is rising in incidence, and with this increase comes additional maternal and fetal risks. Precise diagnosis and timely management of diabetic obstetrical emergencies is critical. In particular, providers must recognize that diabetic ketoacidosis (DKA) may be seen at much lower glucose levels in pregnant patients compared with nonpregnant patients due to physiologic changes of pregnancy. Fluid resuscitation, correction of acidosis and careful electrolyte, glucose, and insulin replacement remain the mainstays of therapy in DKA during pregnancy. Although maternal mortality has decreased over recent decades, fetal mortality remains high, and therefore a multidisciplinary team should guide assessment and treatment of DKA. Decision for early delivery must weigh both the maternal and fetal status and consider adequacy of resuscitative efforts. This chapter provides a brief overview of diabetes in pregnancy with a focus on the diagnosis and management of diabetic emergencies in the obstetrical patient.