Skip to main content

Advertisement

Log in

Management of Diabetes in Pregnancy

  • Diabetes and Pregnancy (CJ Homko, Section Editor)
  • Published:
Current Diabetes Reports Aims and scope Submit manuscript

Abstract

The link between diabetes and poor pregnancy outcomes is well established. As in the non-pregnant population, pregnant women with diabetes can experience profound effects on multiple maternal organ systems. In the fetus, morbidities arising from exposure to diabetes in utero include not only increased congenital anomalies, fetal overgrowth, and stillbirth, but metabolic abnormalities that appear to carry on into early life, adolescence, and beyond. This article emphasizes the newest guidelines for diabetes screening in pregnancy while reviewing their potential impact on maternal and neonatal complications that arise in the setting of hyperglycemia in pregnancy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

ACHOIS:

Australian Carbohydrate Intolerance Study in Pregnant Women

DCCT:

Diabetes Control and Complications Trial

HAPO:

Hyperglycemia and Adverse Pregnancy Outcomes

MiG:

Metformin in Gestational Diabetes

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. •• American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010; 34 (Suppl 1):S62–69. This updates readers on the classification of and possible etiologies of diabetes mellitus.

    Article  Google Scholar 

  2. •• International Association of Diabetes and Pregnancy Study Groups Consensus Panel. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010; 33(3): S76–S82. This is an update on the new recommendations for screening and diagnosing diabetes in pregnancy. It also notes that pregestational diabetes should be diagnosed in the first trimester.

    Article  Google Scholar 

  3. The HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358(19):1991–2002.

    Article  Google Scholar 

  4. • The HAPO Study Cooperative Research Group. Hyperglycemia and Adverse Pregnancy Outcomes: associations with neonatal anthropometrics. Diabetes. 2009; 58(2): 453–459. This secondary analysis of the HAPO trial demonstrates the relationship between maternal hyperglycemia and neonatal anthropometric measurements, which adds support to the Pederson hypothesis.

    Article  Google Scholar 

  5. Hillier TA, Vesco KK, Pedula KL, Beil TL, Whitlock EP, Pettitt DJ. Screening for gestational diabetes mellitus: a systematic review for the US preventive services task force. Ann Intern Med. 2008;148:766–75.

    PubMed  Google Scholar 

  6. Crowther CA, Jiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Australian Carbohydrate Intolerance Study Group in Pregnant Women (ACHOIS) trial group, effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med. 2005;352:2477–86.

    Article  PubMed  CAS  Google Scholar 

  7. •• Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B, Wapner RJ, Varner MW, Rouse DJ, Thorp JM, Sciscione A, Catalano P, Harper M, Saade G, Lain KY, Lain KY, Sorokin Y, Peaceman AM, Tolosa JE, Anderson GB. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med. 2009; 361(14): 1139–1148. This randomized control trial demonstrates that treatment of gestational diabetes is associated with lower rates of macrosomia and fat mass in the neonates of mothers with gestational diabetes.

    Article  Google Scholar 

  8. Jovanovic-Peterson L, Peterson CM, Reed GF, et al. Maternal postprandial glucose levels and infant birth weight: the diabetes in early pregnancy study. Am J Obstet Gynecol. 1991;164:103–11.

    PubMed  CAS  Google Scholar 

  9. de Veciana M, Trail PA, Evans AT, et al. A comparison of oral acarbose and insulin in women with gestational diabetes mellitus. Am J Obstet Gynecol. 2002;99 Suppl 4:S5.

    Google Scholar 

  10. Parretti E, Mecacci F, Papini M. Third trimester maternal glucose level from diurnal profiles in nondiabetic pregnancies—correlation with sonographic paramertes of fetal growth. Diabetes Care. 2001;24:1317–23.

    Article  Google Scholar 

  11. Metzger BE, Buchanan TA, Coustan DR, de Leiva A, Dunger DB, Hadden DR, Hod M, Kitzmiller JL, Kjos SL, Oats JN, Pettitt DJ, Sacks DA, Zoupas C. Summary and recommendations of the fifth international workshop-conference on gestational diabetes mellitus. Diabetes Care. 2007;30:S251–60.

    Article  PubMed  CAS  Google Scholar 

  12. Zucker P, Simon G. Prolonged symptomatic neonatal hypoglycemia associated with maternal chlorpropamide therapy. Pediatrics. 1968;42:824–5.

    PubMed  CAS  Google Scholar 

  13. Towner D, Kjos SL, Leung B, et al. Congenital malformations in pregnancies complicated by NIDDM. Diabetes Care. 1995;18:1446–51.

    Article  PubMed  CAS  Google Scholar 

  14. Elliott BD, Schenker S, Langer O, et al. Comparative placental transport of oral hypoglycemic agents in humans: a model of human placental drug transfer. Am J Obstet Gynecol. 1994;171:653–60.

    PubMed  CAS  Google Scholar 

  15. Langer O, Conway D, Berkus M, et al. A comparison of glyburide and insulin in women with gestational diabetes mellitus. N Engl J Med. 2000;343:1134–8.

    Article  PubMed  CAS  Google Scholar 

  16. Chmait R, Dinise T, Daneshmand S, et al. Prospective cohort study to establish predictors of glyburide success in women with gestational diabetes mellitus. Am J Obstet Gynecol. 2001;185:S197.

    Article  Google Scholar 

  17. Moore TR. Glyburide for the treatment of gestational diabetes: a critical appraisal. Diabetes Care. 2007;30:S209–13.

    Article  PubMed  CAS  Google Scholar 

  18. Jacobson GF, Ramos GA, Ching JY, et al. Comparison of glyburide and insulin for the management of gestational diabetes in a large managed care organization. Am J Obstet Gynecol. 2005;193:118–24.

    Article  PubMed  CAS  Google Scholar 

  19. Coustan DR. Pharmacological management of gestational diabetes: an overview. Diabetes Care. 2007;30:S206–8.

    Article  PubMed  CAS  Google Scholar 

  20. Hebert MF, Ma X, Naraharesetti SB, Krudys KM, Umans JG, Hankins GDV, Caritis SN, Miodovnik M, et al. Are we optimizing gestational diabetes treatment with Glyburide? The pharmacologic basis for better clinical practice. Clin Pharmacol Ther. 2009;85(6):607–14.

    Article  PubMed  CAS  Google Scholar 

  21. Legro RS, Barnhart HX, Schlaff WD, et al. Clomiphene, metformin, or both for infertility in the polycystic ovary syndrome. N Eng J Med. 2007;356:551–66.

    Article  CAS  Google Scholar 

  22. Coetzee EJ, Jackson WP. Metformin in management of pregnant insulin-independent diabetics. Diabetologia. 1979;16:241–5.

    Article  PubMed  CAS  Google Scholar 

  23. Hellmuth E, Damm P, Molsted-Pedersen L. Oral hypoglycaemic agents in 118 diabetic pregnancies. Diabet Med. 2000;17:507–11.

    Article  PubMed  CAS  Google Scholar 

  24. Hughes RC, Rowan JA. Pregnancy in women with type 2 diabetes: who takes metformin and what is the outcome? Diabet Med. 2006;23:318–22.

    Article  PubMed  CAS  Google Scholar 

  25. • Rowan J, Hague W, Gao W, Battin M, Moore P. Metformin versus insulin for the treatment of gestational diabetes. N Engl J Med. 2008; 358(19): 2003–2015. This discusses the first randomized trial of the use of metformin for the treatment of gestational diabetes.

    Article  PubMed  CAS  Google Scholar 

  26. Goh JE, Sadler L, Rowan J. Metformin for gestational diabetes in routine clinical practice. Diabet Med. 2011;28(9):1082–7.

    Article  PubMed  CAS  Google Scholar 

  27. Gabbe SG, Holing E, Temple P, et al. Benefits, risks, costs, and patient satisfaction associated with insulin pump therapy for the pregnancy complicated by type 1 diabetes mellitus. Am J Obstet Gynecol. 2000;182:1283–91.

    Article  PubMed  CAS  Google Scholar 

  28. Mukhopadhyay A, Farrell T, Fraser RB, Ola B. Continuous subcutaneous insulin infusion vs intensive conventional insulin therapy in pregnant diabetic women: a systematic review and metaanalysis of randomized, controlled trials. Am J Obstet Gynecol. 2007;197(5):447–56.

    Article  PubMed  CAS  Google Scholar 

  29. Moore TR, Catalano P. Diabetes in Pregnancy in Creasy RK, Resnik R, Iams JD, Lockwood CJ, Moore TR (Ed.), Creasy and Resnik’s maternal-fetal medicine: principles and practice (6th ed). 2009: 958–967

  30. Landon MB, Catalano PM, Gabbe SG. Diabetes mellitus in Gabbe SG, Niebyl JR, Simpson JL (Ed), Obstetrics, Normal and Problem Pregnancies (4th ed). 2002: 1089–1097.

  31. Sibai BM, Caritis S, Hauth J, et al. Risks of preeclampsia and adverse neonatal outcomes among women with pregestational diabetes mellitus. National institute of child health and human development network of maternal-fetal medicine units. Am J Obstet Gynecol. 2000;182:364–9.

    Article  PubMed  CAS  Google Scholar 

  32. Sibai BM, Ross MG. Hypertension in gestational diabetes mellitus: pathophysiology and long-term consequences. J Matern-Fetal Neo M. 2010;23(3):229–33.

    Article  Google Scholar 

  33. Hawthorne G. Maternal complications in diabetic pregnancy. Best Pract Res CL OB. 2011;25:77–90.

    Article  Google Scholar 

  34. American Diabetes Association. Nephropathy in diabetes—position statement. Diabetes Care. 2004;27(Supp 1):S79–83.

    Google Scholar 

  35. Kitzmiller JL, Block JM, Brown FM, Catalano PM, et al. Managing preexisting diabetes for pregnancy: summary of evidence and consensus recommendations. Diabetes Care. 2008;31(5):1060–79.

    Article  PubMed  CAS  Google Scholar 

  36. Jensen DM, Damm P, Ovesen P, Molsted-Pedersen L, Beck-Nielsen H, Westergaard JG, Moeller M, Mathiesen ER. Microalbuminuria, preeclampsia, and preterm delivery in pregnant women with type 1 diabetes. Diabetes Care. 2010;33(1):90–4.

    Article  PubMed  Google Scholar 

  37. • Nielsen LR, Damm P, Mathiesen ER. Improved pregnancy outcome in type 1 diabetic women with microalbuniuria or diabetic nephropathy – effect of intensified antihypertensive therapy? Diabetes Care. 2009; 32(1): 38–44. This study highlights the importance of meticulous antihypertensive therapy as an adjunct to the treatment of DM1 in pregnancy.

    Article  PubMed  CAS  Google Scholar 

  38. Bhatnagar A, Ghauri AJ, Hope-Ross M, Lip PL. Diabetic retinopathy in pregnancy. Curr Diabetes Rev. 2009;5:151–6.

    Article  PubMed  Google Scholar 

  39. Kollias AN, Ulbig MW. Diabetic retinopathy—early diagnosis and effective treatment. Dtsch Artebl Int. 2010;107(5):75–84.

    Google Scholar 

  40. Carroll MA, Yeomans ER. Diabetic ketoacidosis in pregnancy. Crit Care Med. 2005;33:S347–53.

    Article  PubMed  Google Scholar 

  41. Cullen MT, Reece EA, Homko CJ, et al. The changing presentations of diabetic ketoacidosis during pregnancy. Am J Perinatol. 1996;13:449.

    Article  PubMed  CAS  Google Scholar 

  42. American College of Obstetricians and Gynecologists (ACOG). Clinical management guidelines for obstetrician-gynecologists. ACOG practice bulletin no. 60: pregestational diabetes mellitus. Obstet Gynecol. 2005;105:675–85.

    Article  Google Scholar 

  43. Ma J, Rayner CK, Jones KL, et al. Diabetic gastroparesis. Drugs. 2009;69:971–86.

    Article  PubMed  CAS  Google Scholar 

  44. Camilleri M. Diabetic gastroparesis. N Engl J Med. 2007;356:820.

    Article  PubMed  CAS  Google Scholar 

  45. Miller E, Hare JW, Clohert JP, Dunn PJ, Gleason RE, Soeldner JS, Kitzmiller JL. Elevated hemoglobin A1C in early pregnancy and major congenital anomalies in infants with diabetic mothers. N Engl J Med. 1981;304(22):1331–4.

    Article  PubMed  CAS  Google Scholar 

  46. Becerra JE, Khoury MJ, Cordero JF, et al. Diabetes mellitus during pregnancy and the risks of specific birth defects: a population-based case–control study. Pediatrics. 1990;85:1–9.

    PubMed  CAS  Google Scholar 

  47. Correa A, Gilboa SM, Besser LM, Botto LD, Moore CA, Hobbs CA, Cleves MA, Riehle-Colarusso TJ, Waller DM, Reece A. Diabetes mellitus and birth defects. Am J Obstet Gynecol. 2008;237:e1–9.

    Google Scholar 

  48. Anderson JL, Waller DM, Canfield MA, Shaw GM, Watkins ML, Werler MM. Maternal obesity, gestational diabetes, and central nervous system birth defects. Epidemiology. 2005;16(1):87–92.

    Article  PubMed  Google Scholar 

  49. Remsberg KE, McKeown RE, McFarland KF, Irwin LS. Diabetes in pregnancy and cesarean delivery. Diabetes Care. 1999;22:1561–7.

    Article  PubMed  CAS  Google Scholar 

  50. Keller JD, Lopez-Zeno JA, Dooley SL, Socol ML. Shoulder dystocia and birth trauma in gestational diabetes: a five-year experience. Am J Obstet Gynecol. 1991;165:928.

    PubMed  CAS  Google Scholar 

  51. Mimouni F, Miodovnik M, Rosenn B, et al. Birth trauma in insulin-dependent diabetic pregnancies. Am J Perinatol. 1992;9:205–8.

    Article  PubMed  CAS  Google Scholar 

  52. Nesbitt TS, Gilbert WM, Herrchen B. Shoulder dystocia and associated risk factors with macrosomic infants born in California. Am J Obstet Gynecol. 1998;179:476.

    Article  PubMed  CAS  Google Scholar 

  53. Langer O, Yogev Y, Most O, Xenakis EMJ. Gestational diabetes: the consequences of not treating. Am J Obstet Gynecol. 2005;192:989–97.

    Article  PubMed  Google Scholar 

  54. Ehrenberg HM, Mercer BM, Catalano PM. The influence of obesity and diabetes on the prevalence of macrosomia. Am J Obstet Gynecol. 2004;191:964–4.

    Article  PubMed  CAS  Google Scholar 

  55. Ogata ES, Sabbagha R, Metzger BE, et al. Serial ultrasonography to assess evolving fetal macrosomia: studies in 23 pregnant diabetic women. JAMA. 1980;243:2405.

    Article  PubMed  CAS  Google Scholar 

  56. Catalano PM, Thomas A, Huston-Presley L, Amini SB. Increased fetal adiposity: a very sensitive marker of abnormal in utero development. Am J Obstet Gynecol. 2003;189:1698–704.

    Article  PubMed  Google Scholar 

  57. American College of Obstetricians and Gynecologists (ACOG). Clinical management guidelines for obstetrician-gynecologists. ACOG practice bulletin no. 40: shoulder dystocia. Obstet Gynecol. 2002;100:1045–50.

    Article  Google Scholar 

  58. Kjos SL, Walther FJ, Montoro M, et al. Prevalence and etiology of respiratory distress in infants of diabetic mothers: predictive value of fetal lung maturation tests. Am J Obstet Gynecol. 1990;163:898.

    PubMed  CAS  Google Scholar 

  59. Moore TR. A comparison of amniotic fluid fetal pulmonary phospholipids in normal and diabetic pregnancy. Am J Obstet Gynecol. 2002;186:641–50.

    Article  PubMed  Google Scholar 

  60. Boney CM, Verma A, Tucker R, Vohr BR. Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics. 2005;115:e290–6.

    Article  PubMed  Google Scholar 

  61. Parretti E, Mecacci F, Panini M, et al. Third trimester maternal glucose levels from diurnal profiles in nondiabetic pregnancies: correlation with sonographic parameters of fetal growth. Diabetes Care. 2001;24:1317.

    Article  Google Scholar 

Download references

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Gladys A. Ramos.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ballas, J., Moore, T.R. & Ramos, G.A. Management of Diabetes in Pregnancy. Curr Diab Rep 12, 33–42 (2012). https://doi.org/10.1007/s11892-011-0249-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11892-011-0249-0

Keywords

Navigation