Adverse pregnancy outcomes in women with diabetes

Pregnancy affects both the maternal and fetal metabolism and even in nondiabetic women exerts a diabetogenic effect. As normal pregnancy progresses insulin resistance increases and pancreatic β-cells reserve is stressed aiming to maintain glycemia within normal ranges; gestational diabetes results when β-cells fail to maintain glycemia in these ranges. At delivery, when the placenta that exerts the major anti-insulin effect is removed, usually glucose homeostasis is restored. However, 2 to 17.8% of women develop gestational diabetes, depending on the diagnostic criteria used and the studied population; gestational diabetes represents a very strong predictor for the development of permanent diabetes later in life [1].Besides gestational diabetes, pregnancy can also occur in women with preexisting diabetes. A significant increase in preexisting diabetes during pregnancy has been observed in the USA between 1999 and 2005, rising from 10% to 21% [2]. Pregestational diabetes, both type 1 and type 2 can cause alterations from fertilization, through all pregnancy period and even after its end. It can predispose the fetus to many alterations in organogenesis, growth restriction and predispose the mother to some diabetes-related complications like retinopathy and nephropathy or accelerate the course of these complications if they are already present. Gestational diabetes generally leads to fetal growth alterations [1].The aim of this review is to report the literature on the great incidence of maternal and fetal adverse pregnancy outcomes found nowadays. All these adverse outcomes are closely related to poor glycemic control during the organogenesis period and unfortunately are still very prevalent. Hyperglycemia during the periconceptional period is probably the major teratogenic existing factor, but obesity, hypertension and other factors associated with the metabolic syndrome might also be relevant [1].Normal pregnancy is a non pathological condition characterized by a se