BackgroundPreviously, diabetes was a contraindication to pregnancy, and few live children were born and raised by mothers with diabetes. The current situation is much different, and women with diabetes are no longer discouraged to get pregnant. There are however still many challenges found in pregnancies complicated by diabetes. Improvements have been made, but there are still a higher rate of pre-eclampsia, stillbirths, perinatal death and infant death amongst pregnancies complicated by diabetes. In addition to this, there is also a higher rate of macrosomia and congenital birth defects, such as cardiovascular and neural spine defects. The aim of this project is to look at the obstetric situation for women living with diabetes today, with regard to the kind of preparations that have to be made prior to conception, major health risks during pregnancy for mother and fetus, and the outcomes of the babies and mothers. And lastly, to identify potential areas for improvement of outcome (defined as live healthy newborn, 28 days after delivery). MethodsThe project method is a non-systematic literature review searching the databases PubMed, McMaster PLUS and Cochrane library. The search was limited to original articles and reviews published in English. Search words: diabetes, pregnan*, risk, future, treatment
FindingsThe risk factors in a pragnancy complicated by diabetes can be divided into different groups dependent on what time in the pregnancy it will lead to adverse outcomes and wheter it affects the mother or the baby. The complications known today are congenital malformations, death of fetus/infant, pre-eclampsia, preterm birth, macrosomia/large for gestational age baby, microvascular complications for mother and increased risk for developing diabetes and obesity later in life for mothers with gestational diabetes and offspring of parents with diabetes. DiscussionThe complications for mother and child in pregnancy complicated by diabetes are mainly due to hyperglycemia. To predict to outcome of the pregnancy, one have to look at the degree of hyperglycemia, and at what time in the pregnancy this occures.It is obvious that to mainitain strict glycemic control is a major challenge for those involved.
ConclusionThere are still many challenges in the pregnancy care of women with diabetes. The machanisms behind malformations, premature birth, preeclampsia and stillbirth are still not fully understood, but all of the challenges are related to suboptimal glycemic control in the pregnancy.
To promote healthy lifestyle pre-conceptionally is of outmost importance.