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[Diabetes and pregnancy--optimal management]
Current classification, diagnostic and therapeutic guidelines of diabetes in pregnancy are briefly reviewed in this paper. Obstetricians mainly are confronted with the insulin-dependent diabetic (IDDM) prior to conception and during pregnancy. Intensive interdisciplinary co-operation is considered a prerequisite for treatment of the diabetic patient planning or carrying a pregnancy. The following subspecialties should work together in diabetic pregnant care: Reproductive Medicine incl. high-level endocrinological diagnostics, Diabetology with a teaching facility, and--within a perinatal center--an obstetric and neonatal department experienced in diabetic care. Preconceptional metabolic adjustment as well as surveillance of fetal and maternal condition during the first trimester of pregnancy are considered the mainstay in diabetic patient's care. Possible complications of diabetic pregnancy are described. Only in rare cases, pregnancy is contraindicated because of retino- or nephropathy. The screening program for gestational diabetes is based upon the patient's history, fasting-blood-glucose-levels, 50-g-oral-glucose-tolerance-test (OGTT) and a 24-h-blood-glucose-profile. Measurement of insulin levels in amniotic fluid are recommended for cases that remain yet undiagnosed.
Current classification, diagnostic and therapeutic guidelines of diabetes in pregnancy are briefly reviewed in this paper. Obstetricians mainly are confronted with the insulin-dependent diabetic (IDDM) prior to conception and during pregnancy. Intensive interdisciplinary co-operation is considered a prerequisite for treatment of the diabetic patient planning or carrying a pregnancy. The following subspecialties should work together in diabetic pregnant care: Reproductive Medicine incl. high-level endocrinological diagnostics, Diabetology with a teaching facility, and--within a perinatal center--an obstetric and neonatal department experienced in diabetic care. Preconceptional metabolic adjustment as well as surveillance of fetal and maternal condition during the first trimester of pregnancy are considered the mainstay in diabetic patient's care. Possible complications of diabetic pregnancy are described. Only in rare cases, pregnancy is contraindicated because of retino- or nephropathy. The screening program for gestational diabetes is based upon the patient's history, fasting-blood-glucose-levels, 50-g-oral-glucose-tolerance-test (OGTT) and a 24-h-blood-glucose-profile. Measurement of insulin levels in amniotic fluid are recommended for cases that remain yet undiagnosed.