ABSTRACT
The effects of pregnancy on acute metabolic complications of diabetes may have important
consequences for both mother and fetus. The consequences of pregnancy for chronic
complications of diabetes, including retinopathy, nephropathy, neuropathy, and hypertension,
are not clear. Recent data are reviewed so that health care providers will be able
to provide reasonable advice to insulin-dependent diabetic women contemplating pregnancy
both for problems that may potentially arise during gestation and those that may affect
long-term health and survival. Diabetic ketoacidosis is an uncommon problem that arises
during gestation. Acute alterations in pH and electrolyte concentrations as well as
hyperglycemia, however, may have important consequences for mother and fetus, including
perinatal asphyxia and reduced fetal oxygen delivery. Hypoglycemia, on the other hand,
may result in maternal coma or seizures and, when frequent, has been associated with
infant respiratory distress syndrome. Background retinopathy often worsens during
gestation, with regression common postpartum. Data suggest that progression of background
disease is related to both glycemic control and the acute institution of intensive
insulin therapy with those patients with poor control requiring more aggressive therapeutic
intervention most adversely affected. The course of proliferative retinopathy is more
variable, with both progression and regression reported. Preconception photocoagulation
may prevent progression. Preconceptional ophthalmologic evaluation with frequent assessments
during pregnancy is advised. Increases in 24-hour protein excretion are common during
gestation in patients with preexisting renal disease and resolve in many patients
postpartum. Serum creatinine and creatinine clearance increase during the first trimester
and generally do not change during the remainder of pregnancy. Patients with preexisting
renal disease and hypertension are at risk for development of preeclampsia, whereas
nephropathy appearing during gestation is significantly associated with perinatal
asphyxia. Although pregnancy per se does not appear to affect progression of diabetic
nephropathy, the long-term implications for maternal well-being and survival are serious
and preconceptional counseling is warranted.
