Article Sections

Introduction

Diabetes mellitus (DM) during pregnancy carries significant risks to both the mother and the fetus.  Broadly, it is classified into 2 categories: pregestational DM (which includes both type 1 and type 2 DM) and gestational DM (GDM).  The focus of this article is on pregestational DM (specifically type 1 and type 2 DM) and its implications, management, and outcomes during pregnancy.

Pathophysiology

Type 1 DM (T1DM)
  • T1DM is characterized by autoimmune destruction of pancreatic beta cells, leading to complete insulin deficiency and uncontrolled hyperglycemia.  Patients with T1DM require exogenous insulin for survival.  Placental hormones (human placental lactogen) within pregnancy fluctuate, making glucose control challenging.
  • T1DM in pregnancy is classified as with and without vascular complications (eg, nephropathy, retinopathy).
Type 2 DM (T2DM)
  • T2DM is characterized by progressive loss of insulin secretion, most often in the setting of insulin resistance.  Over time, pancreatic beta cell function declines, leading to worsening hyperglycemia.  Insulin resistance naturally increases during pregnancy, exacerbating glucose control issues.

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Tables

Table 1