The problems of pregnancy in the diabetic may be considered under several headings:

Mental Problems

• Hypoglycemia – Hypoglycemia is common in the first half of pregnancy, especially in the first quarter. Fortunately, the fetus tolerates well hypoglycemia.

• Retinopathy (retinal damage)
Retinopathy is already present in many women at the beginning of pregnancy, and can progress in line is advanced. Regular ophthalmoscopy is therefore important. Paradoxically, the progression of retinopathy may be related to the initiation of a strict metabolic control. When neovascularization, photocoagulation can be controlled, and is not therefore an indication for termination of pregnancy.

* Nephropathy (kidney damage)
Diabetic nephropathy in pregnancy is defined as the presence during the first half of pregnancy proteinuria (presence of protein in the urine) is persistent, more than 400 mg in 24 hours, in the absence of infection.

Many patients also have high blood pressure and other complications resulting from kidney damage. These cases require careful monitoring and control of hypertension and diabetes mellitus, with early hospitalization and inducing labor.
Patients with functioning kidney transplants often have successful pregnancies.

FETAL PROBLEMS

* Malformations
Congenital malformations occur in 6-8% of children of diabetic mothers: they are three times more frequent than in the general population. The rate of malformations covers a broad spectrum, but the defects of the neural canal and cardiac injuries are quite common.

Therefore, you should advise the diabetic women to plan their pregnancy and with prior notice, in order to achieve the best possible control before conception takes place. Compliance with this advice may reduce the number of malformations

* Macrosomia (large size newborn)
* Neonates small for gestational age
Although normal in offspring of diabetic mothers is macrosomia, some babies are small for gestational age, due to intrauterine growth retardation. This is more common in diabetic patients with long evolution of vascular complications.

MORTALITY IN NEWBORN

* Respiratory distress syndrome (RDS) or hyaline membrane disease

When patients routinely pariahs at 36-37 weeks gestation due to lack of maturation of the lungs of the newborn, respiratory disturbance occurred many times it was deadly. Today this problem can be expected to time to avoid many deaths from this cause.

* Hypoglycemia -Neonatal hypoglycaemia is common, especially in children macrosomic. Strict metabolic control of the mother and newborn after birth reduces the frequency and severity of neonatal hypoglycaemia.

Pregnancy is detected by various methods. Pregnancy can be detected by the individual themselves because the signs and symptoms of pregnancy are very obvious. Pregnancy can also be detected by the help of medical people or by undergoing certain medical tests.

There are a number of symptoms like HCG, darkening of the vagina and cervix, Hegar’s sign which is the softening of the uterus isthma and Good ell’s sign, which is the softening of the vaginal portion.

Other symptoms of the pregnancy may include linea Alba – linea nigra pigmentation, which is usually referred to the darkening of the skin in the center of the abdominal area. This happens due to the hormonal changes which usually occur during the middle of the pregnancy period.

Pregnancy diagnosis can usually be accomplished by undergoing various medical tests in which all of them detect the hormones that generate the newly formed placenta. Urine and blood tests can be used to diagnose pregnancy. The main advantage of the blood test is that, it can diagnose pregnancy as early as in the end of the first weeks itself. The usual beginning of the pregnancy is from the time of the last menstrual cycle.

The blood test for pregnancy is more accurate than the urine test and is usually preferred by the medical people. The main disadvantage of the urine test is that, t detects the pregnancy only after 12 to 13 days of the pregnancy only. The primary intention of this test is only to check the state of the embryo and not the age of it.

The blastocyst usually secretes hormones by the name of human choronic gonadotropin. This generally happens in the post menstrual phase. This hormone again stimulates the corpus leutum which is present in the human ovary which continues to produce the progesterone. The main use of this is to create the lining and maintain it which in turn helps in keeping the embryo nourished and healthy.

The lining of the uterus has a gland which swells in respondance to the blastocysts that is triggered to that area. This is done in order to absorb all the vital nutrients that are required for the embryo to nourish properly.

On the other hand, all the signs and symptoms of the pregnancy, some woman won’t realize that they are pregnant till they are in the pregnancy for some time. This is possible due to various reasons like irregular menstrual cycles, taking certain strong medications like painkillers and others. Some of them do not even want to believe that they are pregnant. There are also certain people who do not care if they gain weight.

Pregnancy occurring metabolic adjustments aimed at correcting the imbalance that occurs when a greater nutritional need for the fetus. One of these imbalances is that the body needs more insulin to bring a more precise use of glucose. Clear evidence of this change is experienced by all pregnant women, usually in the morning noticed the unpleasant symptoms of hypoglycemia: nausea, sleepiness, fatigue, weakness, and so on.

Pregnancy progresses, the metabolic adaptation intensifies, reaching great importance during the last 20 weeks of pregnancy. All these metabolic changes lead to a number of considerations when they occur in a diabetic woman:

* In some patients, Diabetes first appears during pregnancy.
* The conventional criteria for diagnosis of diabetes are not applicable during pregnancy
* As the pregnancy progresses there is an increase in insulin needs.
* The usual criteria of strict metabolic control are not applicable during pregnancy

Detection of Diabetes Mellitus (DMG)

The data suggest a DMG are:

* Glycosuria (glucose in urine) in a second fasting urine sample (see below).
* A history of:

* Abortions unexplained.
* Newborns large for gestational age.
* Malformations in the newborn.
* Significant maternal obesity (90 kg or more).

Some minor data are multiparity, toxemia of pregnancy and recurrent preterm birth repeated. The presence of more than one data increases the likelihood that a disorder in glucose metabolism.

Glycosuria (glucose in urine) is a frequent finding, as 15% of pregnant women have, so the search for cases based on this information alone is ineffective. The validity of this test may increase when using a second fasting urine sample, the urine is released into the wake despises and collected a second sample 15 minutes later when the patient is still fasting.

Suspected cases of DMG should be seen every 15 days by the endocrinologist, is working together and the obstetrician. Measures should be taken prenatal routine. There should be special emphasis on weight control. Each visit must be a blood sugar after eating. If this test does not exceed 120 mg / dl), evidence of oral glucose tolerance should be deferred until the 37 th -38 th weeks of gestation, at which time it is more likely to give positive. If at any visit after eating glucose exceeds 120 mg / dl, it should be a test of glucose tolerance without delay. If the test is negative in early pregnancy, however, diagnosis, and the test should be repeated at 37-38 weeks, before making a final decision. Patients who have a negative tolerance test at 37-38 weeks is considered normal.

If the test is positive you can make the diagnosis of gestational diabetes and the patient is given a controlled diet and you are in the same way that a diabetic clinic. If the criteria for ideal glycemic control are not achieved soon, we start treatment with insulin. The existence of a high need for insulin during pregnancy does not necessarily indicate that diabetes persists after birth.

MONITORING OF DMG

After the test should be repeated postpartum glucose tolerance. If the test is still positive, the patient has a diabetes clinic (which was revealed for the first time during pregnancy). If not, the correct diagnosis is gestational diabetes mellitus. As some patients with DM develop clinical DMG then they should be advised to maintain a normal body weight and requested to attend an annual review, or immediately if you become pregnant again.