Pregnancy in a Diabetic Patient. Postpartum. Conclusion

Postpartum

There is an immediate decrease in maternal insulin requirements following delivery. The main reason for this decrease is loss of the placenta, which functioned to synthesize many steroids and create an insulin-resistant environment throughout pregnancy. Postpartum, it is best to start with approximately one-half of the normal prepregnancy dose of insulin and check blood glucose levels before meals and at bedtime to regain tight control. Breastfeeding should be encouraged in both type 1 and 2 diabetic populations. However, patients should be advised about the risk of hypoglycemia from loss of carbohydrates during breastfeeding, and therefore aim for a target fasting (preprandial) glucose level in the range of 110-120 mg/dL. It may even be necessary to take an additional carbohydrate snack prior to breastfeeding and maintain a high calcium and fluid intake.

Neonates of diabetic mothers should be carefully and thoroughly assessed. They are at an increased risk for all the complications previously mentioned and listed in Table 8, including hypoglycemia and respiratory distress syndrome, requiring specialized care.

Conclusion

Table 10 provides a summary of monitoring parameters in a pregnant diabetic patient, from preconception through the first, second, and third trimesters. The overall outlook for the pregnant diabetic patient has improved enormously over the last few decades. The most important aspect of diabetic care for the mother is the need to maintain good glycemic control, with the goal of lessening the risk for congenital malformations and other, later fetal complications. If no major complications are present, good glycemic control and careful monitoring can result in a healthy neonate, with minimal long-term health risk to the mother.

Table 10: Monitoring Factors in a Pregnant Diabetic Patient
	Preconception	First Trimester	Second Trimester	Third Trimester
Well-Woman Exam	X
Thyroid Exam	X
Glycemic Control (HbA1C)	X	X	X	X
Blood Pressure	X	X	X	X
Diet	X	X	X	X
Ultrasound		X	X	X
Renal Function	X	X	X	X
Ophthalmologic Exam	X		X	X
Preeclampsia		X	X	X
Alpha-Fetoprotein			X

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Pregnancy in a Diabetic Patient. Postpartum. Conclusion

Postpartum

Conclusion

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Diabetes and Drugs

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