Even for nondiabetic women maintaining glycemic control during pregrancy may be challenging. Due to hormonal changes, pregnancy increases insulin resistance and therefore the secretion of insulin. Especially obese women, who have developed insulin resistance before gestation, are in high risk of diabetes. As a result 7 percent of nondibetic women may develop gestational diabetes and require treatment during pregnancy. In addition glycemic control is necessary in order to avoid diabetes type 2 after pregnancy and for the children during adulthood.
Health risks during pregnancy.
Uncontrolled diabetes may lead to increased rate of:
Family history of diabetes.
Women who have family history of diabetes and are obese or have given birth to an infant over 4.5 kg are in high risk of gestational diabetes. Obese women, even with mild hyperglycemia may occur severe effects on the developing fetus and may lead to pregnancy complications. Therefore the gynecologist has to check all women for gestational diabetes between 24 and 28 weeks of gestation and prior or as soon as after conception in high risk women.
Women with type 1 or 2 diabetes.
Women with diabetes, who are planning to be pregnant, must achieve glycemic control and receive intensive care before conception. The first trimester of pregnancy is very critical to reduce the risk and to avoid spontaneous abortion. The glycemic control is very important during the 2nd and 3rd trimester of pregnancy, in order to minimize the risk of complications like macrosomin and morbidity in infants.
Nutritional treatment during pregnancy.