Tuesday, November 24,

What will be your approach towards a high risk pregnancy and diabetes mellitus?

Diabetes mellitus is the most common medical complication of pregnancy and it carries a significant risk to the fetus and the mother.

Diabetic mothers are at risk of progression of microvascular diabetic complications as well as early pregnancy loss, pre-eclampsia, polyhydramnios and premature labor.

Gestational diabetes mellitus (GDM) which manifests for the first time during pregnancy iscommon and on the increase, its proper management will reduce the risk of neonatal macrosomia and hypoglycemia.

Pre-pregnancy planning (Table 4) is essential to achieve a healthy baby and avoid maternal morbidity such as adverse pregnancy outcomes and progression of chronic diabetes complications.

Optimise glycemic control:In preparation for pregnancy, oral hypoglycemic agents should be discontinued and insulin started if needed, Diabetic complications should be assessed and treated. Regular self-monitoring should be encouraged to optimize control. Glycemic control should be optimized with the aim of per-prandial blood glucose < 5.5 mmol/l (<95mg/dl) andHbA1c < 7%.

Glucose monitoring: Home blood glucose monitoring is an essential part of maintaining euglycaemic state and its goal is to detect glucose concentration to allow fine-tuning of insulin adjustment.

Dietary advice: The goal of diet in pregnancy is to provide adequate nutrition for the mother and the fetus, provide sufficient calories for appropriate maternal weight gain, maintain normal glycaemia and avoid ketosis. Eating three small to moderate size meals and three snacks per day is appropriate.

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