Diabetes and pregnancy

One must differentiate between pregnants with diabetes mellitus type 1 and women developing gestational diabetes. Most of the type 1 diabetics, but no t women with gestational diabetes (GDM), are cared for adequately as type 1 diabetics have usually been under medical treatment already before pregnan cy. GDM usually starts developing in the 20th week of pregnancy. It appears in about 5 % of pregnants and hence is one of die most frequent gestational di seases. Because of the initial absence of symptoms GDM is frequently not re cognised. Urine tests for glucose are positive only in 50 % of gestation di abetics. Women with gestational diabetes frequently suffer from urinary tra ct infections during pregnancy, and their children often develop postnatal hypoglycemia or icterus and later diabetes mellitus. As screening method, a dose of 50 mg glucose by the oral route, independent of any food consumed before and of the time of the day is recommended. In case of an increased v alue (> 140 mg/dl) an oral glucose tolerance test is necessary for diagnost ic purpose. Gestational diabetes is treated primarily by a change in diet w hich normalizes blood sugar values in 90 % of the cases. In 10 % of cases i nsulin is necessary in addition. Energy requirements are calculated on the basis of 30 kcal/kg body weight. The diet should be rich in complex carbohy drates. Patients with a low body mass index should gain more weight during pregnancy than patients with a high body mass index. Adequate care of these high-risk pregnants reduces the risks of mother and child down to that of metabolically healthy pregnants.