Diabetes mellitus and pregnancy

Pregnancy is a “diabetogenic state”; the progressive insulin resistance which develops during pregnancy as a result of placental production of diabetogenic hormones serves to decrease glucose entry into maternal cells and to preserve fuel for the developing fetus. Gestational diabetes mellitus (glucose intolerance first recognized during pregnancy; GDM), develops in some women during pregnancy when pancreatic B-cell function is insufficient to overcome the insulin resistance that occurs during pregnancy. In women who have preexisting diabetes mellitus (DM) who become pregnant, the physiologic metabolic alterations of pregnancy create unique therapeutic challenges, including large changes in insulin requirements over the course of the pregnancy. Several adverse fetal, neonatal, obstetric, and maternal outcomes have been associated with diabetes during pregnancy, and treatment reduces risk of several complications for both women and their infants. In addition, the altered intrauterine environment that results from hyperglycemia during pregnancy has lifelong health implications for the mother and infant which extend well beyond pregnancy. GDM during pregnancy predicts a markedly increased risk for the future development of type 2 diabetes, and alterations in maternal glucose metabolism in utero can influence the infant?s long-term future risk for obesity and abnormal glucose metabolism.