Women with diabetes face particular problems during pregnancy. There is a need for increased insulin with the progress of pregnancy and tight dietary control. Such women require the joint care of a physician interested in diabetes and an obstetrician.
Even with this there is a tendency for the baby to grow big presenting possible problems for delivery.
There is also a risk of unexpected fetal compromise in the late stages of the antenatal period. This can be difficult to detect and treatment is to proceed to planned delivery close to term.
In some populations there is a significant incidence of diabetes in pregnancy in previously normal women. It can come in pregnancy and disappear after the baby is born (gestational diabetes). It is probably important to detect this. As it occurs in normal women such women require to be screened. It is probably most important in overweight, older women.
Such screening is done in different ways but is probably effective with a single random blood sugar test at 26-28 weeks of gestation. If it is abnormal a glucose tolerance test is arranged.
Women with diabetes require careful supervision during labour.
This involves:
- Control of the sugar level with an insulin infusion,
- electronic fetal heart monitoring and
- plans for the delivery of a big baby.
Written by Medpages Editorial Team
Last Editorial Review:20/1/2010
