Complications of gestational diabetes mellitus.

By | 15th May 2012

 

 

Maternal complications

 

  1. Asymptomatic bacteremia

 

It is thought to occur 2-3 times more frequently in women with glucose in urine. It should be diagnosed early and managed by antibiotics

 

  1. Pyelonephritis.

 

It is exaggerated complication of bacteremia that results when women with bacteremia is not treated properly.

 

  1. Diabetic retinopathy.

 

Development or worsening of diabetic retinopathy during pregnancy depends on duration of diabetes .pregnancy enhances the progress because it worsens the glucose intolerance. In ignored case, proliferative retinitis and macular edema may ensue.

 

  1. Preeclampsia and eclampsia

They seem to be more common in diabetic women, particularly as term approaches but worsening proteinuria may occur without evidence of preeclampsia and eclampsia.

 

  1. Diabetic ketoacidosis.

When ketoacidosis occur, it presents as an emergency and prompt correction of metabolic acidosis or maternal death.

 

  1. Thromboembolic disease.

 

It is more common in pregnant women with diabetes.

 

  1. Preterm labor.

 

There is greatly increased risk for having preterm labor in pregnant women; therefore tocolytic drugs are used along with intravenous infusion of insulin.

 

  1. Vaginitis and vulvitis:

 

Due to glycosuria, candidiasis of vagina and vulva may develop. Superimposed bacterial infection may worsen the picture.

 

 

  1. Polyhydramnios:

 

It is common complication. it is related to fetal and placental size and to poor control of diabetes, rather than severity of diabetes.

 

  1. Dystocia:

 

Due to enlarge baby, vaginal delivery is difficult and always requires episiotomy .if fails then do C-Section.

 

Fetal complications:

 

  1. Congenial anomalies

There are about 4 times more common with neural tube defects and cardiac abnormalities predominantly.

  1. Macrosomia

Unsatisfactory metabolic environment usually leads to obstructed labor or shoulder dystocia.

  1. Intrauterine asphyxia
  2. Hypoglycemia
  3. Hyperbilirubinemia
  4. Sudden intrauterine fetal death.

 

Prevention:

 

All of the above mentioned complications can be prevented by maintaining a normoglycemic state i.e. glucose level below 6mmol /liter fasting below 8 mmol /l postprandial.

 

Diet control

 

Daily carbohydrates intake must not exceed 150gm.

 

Insulin

 

Most of the patient can be satisfactorily controlled by twice daily injections of a combination of short and intermediate action insulin.