Approach to the Patient with Diabetes during Pregnancy

The epidemics of obesity and type 2 diabetes mellitus (T2DM) globally are paralleling an increase in the number of women with T2DM becoming pregnant. Because T2DM is frequently undiagnosed before pregnancy, the risk of major malformations in the developing fetus is increased due to uncontrolled hyperglycemia. The lack of preconception care and the increase in complications of pregnancy due to the coexistence of obesity and T2DM are of concern from both an individual and a public health standpoint. Rapid achievement of normoglycemia with limited weight gain is critical to optimize maternal and fetal outcomes in all women with diabetes during pregnancy, regardless of the type of diabetes. This article will focus on T2DM preceding pregnancy due to its increasing prevalence and potentially dire fetal and maternal consequences. Euglycemia before, during, and after all pregnancies complicated by diabetes results in the best opportunity for optimal outcomes for mother and infant.