Vascular complications in diabetic pregnancy

Until now, vascular complications in diabetic pregnancy are mainly related to hyperglycemia caused by type 1 diabetes (Type 1 DM). Progression of diabetic retinopathy (DR) occurs at least temporarily during pregnancy and postpartum. There is a short-term increase in the level of retinopathy during pregnancy that persisted into the first year postpartum. Nephropathy is associated with increased risk of preeclampsia, nephrotic syndrome, preterm delivery, fetal growth restriction, and perinatal mortality. Presence of retinopathy increases also risk of preeclampsia and also poor glycemic control. The pregnancy itself (first or subsequent) is not a long-term risk factor for developing microalbuminuria, any retinopathy, proliferative retinopathy, or neuropathy. The prevalence of type 2 diabetes (Type 2 DM) is rising leading to similar or even worse pregnancy outcome than in T1 DM. Micro- and macroangiopathic complications still rather rare in the mother will also become more prevalent with increasing age, obesity and more severe forms of Type 2 DM. Good glycemic control, normotension, lack of nephropathy as well as lack of pre-proliferative/proliferative changes of diabetic retinopathy and lack of signs of macroangiopathies are good prognostic factors as regards the progression of vascular complications during pregnancy. Women with diabetes should be evaluated before pregnancy for microangiopathies, treated and followed closely during pregnancy by obstetrician, internist/diabetologue, cardiologist and ophthalmologist and nephrologist.