21. Diabetes Mellitus

  1. John T. Queenan MD2,
  2. Catherine Y. Spong MD3 and
  3. Charles J. Lockwood MD4
  1. George Saade MD

Published Online: 4 JAN 2012

DOI: 10.1002/9781119963783.ch21

Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach, Sixth Edition

Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach, Sixth Edition

How to Cite

Saade, G. (2012) Diabetes Mellitus, in Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach, Sixth Edition (eds J. T. Queenan, C. Y. Spong and C. J. Lockwood), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781119963783.ch21

Editor Information

  1. 2

    Department of Obstetrics and Gynecology, Georgetown University School of Medicine, Washington, DC, USA

  2. 3

    Bethesda, MD, USA

  3. 4

    Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA

Author Information

  1. Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, USA

Publication History

  1. Published Online: 4 JAN 2012
  2. Published Print: 24 FEB 2012

ISBN Information

Print ISBN: 9780470655764

Online ISBN: 9781119963783

SEARCH

Keywords:

  • diabetes mellitus;
  • goal, decreasing risk for congenital anomalies, in hyperglycemia;
  • glucose monitoring, pharmacologic, and fetal surveillance;
  • perinatal mortality, complicated by insulin-dependent diabetes;
  • careful history and physical examination;
  • maternal glycemia regulation, euglycemia maintenance;
  • major fetal malformations, in type 1 diabetes;
  • insulin management during labor;
  • fetal weight, growth sonography, in fetal macrosomia

Summary

As more women with diabetes are contemplating pregnancy and more women are delaying pregnancy, healthcare providers should expect to see more pregnant women with pregestational as well as gestational diabetes. Management of these women should follow accepted guidelines in order to decrease maternal and perinatal morbidity and mortality. To that effect, the central goal is to decrease the risk for congenital anomalies secondary to preconception hyperglycemia, as well as to shepherd the pregnant woman through pregnancy in order to reach term without maternal complications such as preeclampsia or fetal complications such as uteroplacental insufficiency, antepartum stillbirth, macrosomia, birth injury, and postnatal hypoglycemia. This can be achieved by a combination of frequent glucose monitoring, dietary and pharmacologic interventions, diligent fetal surveillance, appropriate timing of delivery, and judicious choice of delivery route. In most cases, diabetic patients can be brought to term, and perinatal mortality from stillbirth, prematurity, and birth injury can be markedly reduced. It is important that the obstetrician who occasionally manages diabetic patients is familiar with the uses and limitations of established treatments. This chapter concentrates on the pregestational diabetic patient. For discussion of gestational diabetes, see Chapter 20.