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26-01-2016 | Pregnancy | Review | Article

Identifying Key Intervention Opportunities During a Pregnancy Complicated by Diabetes: a Review of Acute Complications of Diabetes During Pregnancy

Journal: Current Diabetes Reports

Authors: Paige K. Bradley, Marissa Duprey, Kristin Castorino

Publisher: Springer US

Abstract

Diabetes in pregnancy is associated with significant and sometimes devastating acute complications. It is important that all health care providers are aware of possible complications at each stage of pregnancy so that we can prevent these complications whenever possible and reduce morbidity when they do occur. Most complications associated with diabetes during pregnancy have reduced incidence when blood glucose and blood pressure are optimally controlled. Yet, it is always best to try to optimize diabetes and any comorbidities prior to conception.
Literature
1.
American Diabetes Association Standards of Medical Care in Diabetes—2015. Diabetes Care. 2015;38(Suppl 1):S8–S16. doi:10.​2337/​dc15-S005.
2.
Castorino K, Jovanovič L. Pregnancy and diabetes management: advances and controversies. Clin Chem. 2011;57(2):221–30. doi:10.​1373/​clinchem.​2010.​155382.CrossRefPubMed
3.
DeSisto CL, Kim SY, Sharma AJ. Prevalence Estimates of Gestational Diabetes Mellitus in the United States, Pregnancy Risk Assessment Monitoring System (PRAMS), 2007–2010. Prev Chronic Dis. 2014;11:130415. doi:10.​5888/​pcd11.​130415.CrossRef
4.
Anna V et al. Sociodemographic correlates of the increasing trend in prevalence of gestational diabetes mellitus in a large population of women between 1995 and 2005. Diabetes Care. 2008;31(12):2288–93.PubMedCentralCrossRefPubMed
5.
Lawrence JM et al. Trends in the prevalence of preexisting diabetes and gestational diabetes mellitus among a racially/ethnically diverse population of pregnant women, 1999–2005. Diabetes Care. 2008;31(5):899–904.CrossRefPubMed
6.
Kitzmiller JL, et al. Managing Preexisting Diabetes for Pregnancy. Diabetes Care. 2008;31(5). doi: 10.​2337/​dc08-9020.
7.
Jovanociv L, et al. Trends in the incidence of diabetes, its clinical sequelae, and associated costs in pregnancy. Diabetes Metab Res Rev. 2015. Published online in Wiley Online Library (wileyonlinelibrary.com) doi: 10.​1002/​dmrr.​2656.
8.
Correa A et al. Diabetes mellitus and birth defects. Am J Obstet Gynecol. 2008;199(3):237-e1.CrossRef
9.
Gonzalez-Campoy JM et al. Clinical practice guidelines for healthy eating for the prevention and treatment of metabolic and endocrine diseases in adults: co-sponsored by the American Association of Clinical Endocrinologists/the American College of Endocrinology and the Obesity Society: executive summary. Endocr Pract. 2013;19(5):875–87. doi:10.​4158/​EP13155.​ESGL.CrossRefPubMed
10.
Finer LB, Zolna MR. Unintended pregnancy in the United States: incidence and disparities, 2006. Contraception. 2011;84(5):478–85.PubMedCentralCrossRefPubMed
11.
Mosher WD, Jones J, and Joyce CA. Intended and unintended births in the United States: 1982–2010. 2012;1–28.
12.
Santelli J, et al. The measurement and meaning of unintended pregnancy. Perspect Sex Reprod Health. 2003;94–101.
13.
Nielson LR et al. Hypoglycemia in pregnant women with type 1 diabetes: predictors and role of metabolic control. Diabetes Care. 2008;31(1):9–14. doi:10.​2337/​dc07-1066.CrossRef
14.
Childs B et al. Strategies to limit the effect of hypoglycemia on diabetes control: identifying and reducing the risks. Clin Diabetes. 2012;30(1):28–33. doi:10.​2337/​diaclin.​30.​1.​28.CrossRef
15.
Clarke WL et al. Reduced awareness of hypoglycemia in adults with IDDM: a prospective study of hypoglycemic frequency and associated symptoms. Diabetes Care. 1995;18(4):517–22.CrossRefPubMed
16.
Palerm CC et al. A Run-to-Run Control Strategy to Adjust Basal Insulin Infusion Rates in Type 1 Diabetes. J Process Control. 2008;18(3–4):258–65. doi:10.​1016/​j.​jprocont.​2007.​07.​010.PubMedCentralCrossRefPubMed
17.
Zisser H et al. Clinical update on optimal prandial insulin dosing using a refined run-to-run control algorithm. J Diabetes Sci Technol. 2009;3(3):487–91.PubMedCentralCrossRefPubMed
18.
Murphy HR, et al. Effectiveness of continuous glucose monitoring in pregnant women with diabetes: randomised clinical trial. BMJ. 2008;337.
19.
Secher AL et al. The Effect of Real-Time Continuous Glucose Monitoring in Pregnant Women With Diabetes. Diabetes Care. 2013;36(7):1877–83.PubMedCentralCrossRefPubMed
20.
American Diabetes Association. Medical Management of Type 1 Diabetes. 6th edition. 2012.
21.
American Diabetes Association. Management of Pregnancy Complicated by Diabetes. 5th edition. 2013.
22.
Klein BEK, Moss SE, Klein R. Effect of pregnancy on progression of diabetic retinopathy. Diabetes Care. 1990;13(1):34–40.CrossRefPubMed
23.
Rasmussen LK et al. Progression of diabetic retinopathy during pregnancy in women with type 2 diabetes. Diabetologia. 2010;53(6):1076–83. doi:10.​1007/​s00125-010-1697-9.CrossRefPubMed
24.
The Diabetes Control and Complications Trial. Effect of Pregnancy on Microvascular Complications in the Diabetes Control and Complications Trial. Diabetes Care. 2000;23(8):1084–91. doi:10.​2337/​diacare.​23.​8.​1084.CrossRef
25.
Chew EY et al. Metabolic control and progression of retinopathy: the Diabetes in Early Pregnancy Study. Diabetes Care. 1995;18(5):631–7.CrossRefPubMed
26.
American Diabetes Association. Standards of medical care in diabetes—2009. Diabetes Care. 2009;32(Supplement 1):S13–61.PubMedCentralCrossRef
27.
Nevis IF, Reitsma A, Dominic A, et al. Pregnancy outcomes in women with chronic kidney disease: a systematic review. Clin J Am Soc Nephrol. 2011;6:2587.PubMedCentralCrossRefPubMed
28.
Gillon TE, Pels A, von Dadelszen P, et al. Hypertensive disorders of pregnancy: a systematic review of international clinical practice guidelines. PLoS One. 2014;9:e113715.PubMedCentralCrossRefPubMed
29.
Vestgaard M et al. Thyroid peroxidase antibodies in pregnant women with type 1 diabetes: impact on thyroid function, metabolic control and pregnancy outcome. Acta Obstet Gynecol Scand. 2008;87(12):1336–42.CrossRefPubMed
30.
Dashe JS et al. Thyroid-stimulating hormone in singleton and twin pregnancy: importance of gestational age–specific reference ranges. Obstet Gynecol. 2005;106(4):753–7.CrossRefPubMed
31.
Alvarez-Marfany M et al. Long-term prospective study of postpartum thyroid dysfunction in women with insulin dependent diabetes mellitus. J Clin Endocrinol Metab. 1994;79(1):10–6.PubMed
32.
Nicholson WK. Prevalence of postpartum thyroid dysfunction: a quantitative review. Thyroid. 2006;16(6):573–82. doi:10.​1089/​thy.​2006.​16.​573.CrossRefPubMed
34.
Garner PR et al. Preeclampsia in diabetic pregnancies. Am J Obstet Gynecol. 1990;163:505–8.CrossRefPubMed
35.
Ros HS, Cnattingius S, Lipworth L. Comparison of risk factors for preeclampsia and gestational hypertension in a population-based cohort study. Am J Epidemiol. 1998;147(11 suppl):1062–70.CrossRefPubMed
36.
Duckitt K, Harrington D. Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. BMJ. 2005;330(7491):565.PubMedCentralCrossRefPubMed
37.
Holmes VA et al. Diabetes and Pre-eclampsia Intervention Trial Study Group. Optimal glycemic control, preeclampsia, and gestational hypertension in women with type 1 diabetes in the diabetes and pre-eclampsia intervention trial. Diabetes Care. 2011;34:1683–8.PubMedCentralCrossRefPubMed
38.
Li DK, Liyan L, Odouli R. Exposure to non-steroidal anti-inflammatory drugs during pregnancy and risk of miscarriage: population based cohort study. BMJ. 2003;327(7411):368.PubMedCentralCrossRefPubMed
39.
Janssen NM, Genta MS. The effects of immunosuppressive and anti-inflammatory medications on fertility, pregnancy, and lactation. Arch Intern Med. 2000;160(5):610–9.CrossRefPubMed
40.
Bujold E, et al. Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis. Obstet Gynecol. 116.2, Part 1 (2010): 402–414.
41.
Roberge S et al. Early administration of low-dose aspirin for the prevention of severe and mild preeclampsia: a systematic review and meta-analysis. Obstet Gynecol Surv. 2012;67(12):760–2.CrossRef
42.•
Schisterman EF et al. Preconception low-dose aspirin and pregnancy outcomes: results from the EAGeR randomised trial. Lancet. 2014;384(9937):29–36. This is one of the first randomized trials investigating the short-term and long-term use of aspirin just before and during pregnancy. Aspirin is a low-cost and easily accessed over-the-counter drug that can mitigate risks due to maternal hypertension and cardiovascular disease among other complications.PubMedCentralCrossRefPubMed
43.
Cerneca F et al. Coagulation and fibrinolysis changes in normal pregnancy. Increased levels of procoagulants and reduced levels of inhibitors during pregnancy induce a hypercoagulable state, combined with a reactive fibrinolysis. Eur J Obstet Gynecol Reprod Biol. 1997;73(1):31–6.CrossRefPubMed
44.
Berg CJ et al. Pregnancy-related mortality in the United States, 1998 to 2005. Obstet Gynecol. 2010;116(6):1302–9.CrossRefPubMed
45.
Ghaji N et al. Trends in venous thromboembolism among pregnancy-related hospitalizations, United States, 1994–2009. Am J Obstet Gynecol. 2013;209(5):433-e1.CrossRef
46.
Marik PE, Plante LA. Venous thromboembolic disease and pregnancy. N Engl J Med. 2008;359(19):2025–33.CrossRefPubMed
47.
Bertoni AG, Saydah S, Brancati FL. Diabetes and the risk of infection-related mortality in the US. Diabetes Care. 2001;24(6):1044–9.CrossRefPubMed
48.
Hill JB et al. Acute pyelonephritis in pregnancy. Obstet Gynecol. 2005;105(1):18–23.CrossRefPubMed
49.
Ramos E et al. Group B streptococcus colonization in pregnant diabetic women. Obstet Gynecol. 1997;89(2):257–60.CrossRefPubMed
50.
Grundy SM et al. Diabetes and cardiovascular disease a statement for healthcare professionals from the American Heart Association. Circulation. 1999;100(10):1134–46.CrossRefPubMed
51.
Kannel WB, Hjortland M, Castelli WP. Role of diabetes in congestive heart failure: the Framingham study. Am J Cardiol. 1974;34(1):29–34.CrossRefPubMed
52.
Nathan DM et al. Diabetes control and complications trial/epidemiology of diabetes interventions and complications study at 30 years: advances and contributions. Diabetes. 2013;62(12):3976–86.PubMedCentralCrossRefPubMed
53.
Hunter S, Robson SC. Adaptation of the maternal heart in pregnancy. Br Heart J. 1992;68(6):540.PubMedCentralCrossRefPubMed
54.
Ladner HE, Danielsen B, Gilbert WM. Acute myocardial infarction in pregnancy and the puerperium: a population-based study. Obstet Gynecol. 2005;105(3):480–4.CrossRefPubMed
55.
Parker JA, Conway DL. Diabetic ketoacidosis in pregnancy. Obstet Gynecol Clin N Am. 2007;34(3):533–43.CrossRef
56.
Sibai BM, Viteri OA. Diabetic ketoacidosis in pregnancy. Obstet Gynecol. 2014;123(1):167–78.CrossRefPubMed
57.
Guo RX et al. Diabetic ketoacidosis in pregnancy tends to occur at lower blood glucose levels: case–control study and a case report of euglycemic diabetic ketoacidosis in pregnancy. J Obstet Gynaecol Res. 2008;34(3):324–30.CrossRefPubMed
58.
Bedalov A. Glucocorticoid-induced ketoacidosis in gestational diabetes: sequela of the acute treatment of preterm labor: a case report. Diabetes Care. 1997;20(6):922–4.CrossRefPubMed
59.
Maislos M, Harman-Bohem I, Weitzman S. Diabetic ketoacidosis: a rare complication of gestational diabetes. Diabetes Care. 1992;15(8):968–70.CrossRefPubMed
60.
Madaan M et al. Diabetic ketoacidosis occurring with lower blood glucose levels in pregnancy: a report of two cases. J Reprod Med. 2011;57(9–10):452–5.
61.
Marcinkevage JA, Venkat Narayan KM. Gestational diabetes mellitus: taking it to heart. Primary Care Diabetes. 2011;5(2):81–8.CrossRefPubMed
62.
Roeder HA, Moore TR, Ramos GA. Insulin pump dosing across gestation in women with well-controlled type 1 diabetes mellitus. Am J Obstet Gynecol. 2012;207(4):324-e1.CrossRef
63.•
Kallas-Koeman MM et al. Insulin pump use in pregnancy is associated with lower HbA1c without increasing the rate of severe hypoglycaemia or diabetic ketoacidosis in women with type 1 diabetes. Diabetologia. 2014;57(4):681–9. This study is of importance because it confirms that improving diabetes technology relieves the burden of diabetes complications even during pregnancy.CrossRefPubMed
64.
Castorino K et al. Insulin pumps in pregnancy: using technology to achieve normoglycemia in women with diabetes. Curr Diab Rep. 2012;12(1):53–9. doi:10.​1007/​s11892-011-0242-7.CrossRefPubMed
65.
Weiner Z et al. Clinical and ultrasonographic weight estimation in large for gestational age fetus. Eur J Obstet Gynecol Reprod Biol. 2002;105(1):20–4.CrossRefPubMed
66.
Bonsack CF, Lathrop A, Blackburn M. Induction of labor: update and review. J Midwifery Womens Health. 2014;59(6):606–15.CrossRefPubMed
67.
Persson M, Norman M, Hanson U. Obstetric and perinatal outcomes in type 1 diabetic pregnancies: a large, population-based study. Diabetes Care. 2009;32(11):2005–9.PubMedCentralCrossRefPubMed
68.
Stanley K et al. Physiological changes in insulin resistance in human pregnancy: longitudinal study with the hyperinsulinaemic euglycemia clamp technique. Br J Obstet Gynaecol. 1998;105:756–9.CrossRefPubMed
69.
Neubauer SH et al. Delayed lactogenesis in women with insulin-dependent diabetes mellitus. Am J Clin Nutr. 1993;58(1):54–60.PubMed
70.
AAP Breastfeeding and the Use of Human Milk, Pediatrics. 2012;129(3).
71.
Hummel S et al. Breastfeeding habits in families with type I diabetes. Diabet Med. 2007;24:671–6.CrossRefPubMed
72.•
Finkelstein SA et al. Breastfeeding in women with diabetes: lower rates despite greater rewards. A population based study. Diabet Med. 2013;30:1094–101. Although breast feeding has clear benefits for the infant, the significant benefits for the mother are underappreciated. As breast feeding can improve blood sugar control as well as improve maternal-bonding, the practice has multifaceted benefits for the entire family.CrossRefPubMed
73.
Schoen S et al. Breastfeeding duration in families with type I diabetes compared to non-affected families from BABYDIAB and DONALD studies in Germany. Breastfeed Med. 2008;3:171–5.CrossRefPubMed
74.
Ostrom KM et al. Prolactin concentrations in serum milk and milk of mothers with and without insulin dependent diabetes mellitus. Am J Clin Nutr. 1993;58(1):49–53.PubMed
75.
Moore, TR. Managing Diabetes and During Pregnancy and Postpartum. CDAPP Sweet Success Webinar. 2015.
76.
Bellamy L et al. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet. 2009;373:1773–9.CrossRefPubMed
77.
Bottalico JN. Recurrent gestational diabetes: risk factors, diagnosis, management and implications. Semin Perinatol. 2007;31:176–84. doi:10.​1053/​j.​semeri.​2007.​03.​006.CrossRefPubMed
78.
Metzger BE et al. Summary and recommendations of the 5th international workshop conference on gestational diabetes mellitus. Diabetes Care. 2007;30 suppl 2:S251–60.CrossRefPubMed
79.
Kim C et al. Missed Opportunities for Type 2 Diabetes Mellitus Screening Among Women With a History of Gestational Diabetes Mellitus. Am J Public Health. 2006;96(9):1643–8. doi:10.​2105/​AJPH.​2005.​065722.PubMedCentralCrossRefPubMed
80.
American Diabetes Association. Position Statement: Gestational Diabetes Mellitus. Diabetes Care. 2004;27(Supplemental I). doi:10.​2337/​diacare.​27.​2007.​S88.
81.
Vrachnis N, et al. Previous gestational diabetes mellitus and markers of cardiovascular risk. Int J Endocrinol. 2012.
82.
Carr DB et al. Gestational diabetes mellitus increases the risk of cardiovascular disease in women with a family history of type 2 diabetes. Diabetes Care. 2006;29:2078–83.CrossRefPubMed
83.
Shah BR et al. Increased risk of cardiovascular disease in young women following gestational diabetes mellitus. Diabetes Care. 2008;31(8):1668–9. doi:10.​2337/​dc08-0706.PubMedCentralCrossRefPubMed
84.
Bennett WL et al. Barriers to and facilitators of postpartum follow-up care in women with recent gestational diabetes mellitus: a qualitative study. J Women's Health. 2011;20(2):239–45. doi:10.​1089/​jwh.​2010.​2233.CrossRef
85.
Harris A, et al. Emergency Room Utilization After Medically Complicated Pregnancies: A Medicaid Claims Analysis. J Women's Health. 2015.
86.
U.S. Department of Health and Human Services. Health Resources and Services Administration: Maternal and Child Health Segment. Maternal, infant and early childhood home visiting program. Available at http://​mchb.​hrsa.​gov/​programs/​homevisiting. Accessed September 27, 2015.
87.
Jacobson PD, Jazowski SA. Physicians, the Affordable Care Act, and primary care: disruptive change or business as usual? J Gen Intern Med. 2011;26(8):934–7.PubMedCentralCrossRefPubMed
88.
Grumbach K, Bodenheimer T. Can health care teams improve primary care practice? JAMA. 2004;291(10):1246–51.CrossRefPubMed
89.
Castorino K, Jovanovic L. The postpartum management of women with gestational diabetes using a continuum model for health care. Clin Obstet Gynecol. 2013;56(4):853–9.CrossRefPubMed

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