Diabetes in pregnancy

The diabetes epidemic is sweeping the globe. In 2011, 366 million people worldwide had diabetes; by 2030, that number is projected to almost double. More than eight million women in the United States have pregestational diabetes mellitus, and it is observed in 1 % of all pregnancies [1]. Studies suggest that the prevalence of diabetes among women of childbearing age is increasing in the United States [2]. Many of these women are undiagnosed until pregnancy. Type 2 diabetes, which is the most common type, is associated with obesity and insulin resistance. Long-standing diabetes mellitus can result in significant end-organ damage and lead to vasculopathy, retinopathy, nephropathy, and heart disease. The prenatal care of the diabetic woman can be quite complex and can have significant impact on the short-term and long-term health of the mother and the fetus. Care starts with disease control and glucose optimization, ideally in the preconception period. This can help to minimize disease progression of diabetes mellitus and can also mitigate the effects of diabetes on pregnancy, including increased risk of miscarriage, teratogenicity, preterm birth, preeclampsia, and growth restriction or macrosomia. For the many women who are not diagnosed with diabetes mellitus until pregnancy, this prenatal time period can be a unique opportunity to educate women about this chronic disease. In women with risk factors for diabetes mellitus who develop gestational diabetes, the caregiver should suspect preexisting diabetes and ensure that testing, treatment, and follow-up are arranged. With strict glycemic control, the diabetic gravida can anticipate minimal disease complications and good pregnancy outcomes.