Managing type 1 diabetes mellitus in pregnancy—from planning to breastfeeding

ABSTRACT Type 1 diabetes mellitus in pregnant women increases the risk of adverse outcomes for mother and offspring. Careful preconception counselling and screening is important, with

particular focus on glycaemic control, indications for antihypertensive therapy, screening for diabetic nephropathy, diabetic retinopathy and thyroid dysfunction, as well as review of other

medications. Supplementation with folic acid should be initiated before conception in order to minimize the risk of fetal malformations. Obtaining and maintaining tight control of blood

glucose and blood pressure before and during pregnancy is crucial for optimizing outcomes; however, the risk of severe hypoglycaemia during pregnancy is a major obstacle. Although pregnancy

does not result in deterioration of kidney function in women with diabetic nephropathy and normal serum creatinine levels, pregnancy complications such as pre-eclampsia and preterm delivery

are more frequent in these women than in women with T1DM and normal kidney function. Rapid-acting insulin analogues are considered safe to use in pregnancy and studies on long-acting insulin

analogues have provided reassuring results. Immediately after delivery the insulin requirement declines to approximately 60% of the prepregnancy dose, and remains 10% lower than before

pregnancy during breastfeeding. KEY POINTS * Tight maternal glycaemic and blood pressure control is crucial, and hypoglycaemia must be avoided during pregnancy * Insulin analogues can be

used before and during pregnancy * Folic acid supplementation should be initiated before conception and continued to the end of the first trimester * Maternal screening for retinopathy and

nephropathy should be carried out * Close surveillance of fetus and newborn baby is important Access through your institution Buy or subscribe This is a preview of subscription content,

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ACTIONS AND CLINICAL APPLICATIONS Article 25 October 2024 PRECISION GESTATIONAL DIABETES TREATMENT: A SYSTEMATIC REVIEW AND META-ANALYSES Article Open access 05 October 2023 EARLY PREGNANCY

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Download references AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Center for Pregnant Women with Diabetes, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen Ø, DK 2100,

Denmark Lene Ringholm, Elisabeth R. Mathiesen, Louise Kelstrup & Peter Damm Authors * Lene Ringholm View author publications You can also search for this author inPubMed Google Scholar *

Elisabeth R. Mathiesen View author publications You can also search for this author inPubMed Google Scholar * Louise Kelstrup View author publications You can also search for this author

inPubMed Google Scholar * Peter Damm View author publications You can also search for this author inPubMed Google Scholar CONTRIBUTIONS L. Ringholm contributed to researching and discussing

content, writing the manuscript and editing the article before submission. E. R. Mathiesen, L. Kelstrup and P. Damm contributed substantially to discussions of the content and reviewing

and/or editing of the manuscript before submission. CORRESPONDING AUTHOR Correspondence to Lene Ringholm. ETHICS DECLARATIONS COMPETING INTERESTS P. Damm and E. R Mathiesen have acted as

consultants for and received grant support from Novo Nordisk. E. R. Mathiesen has also received honoraria from Novo Nordisk. L. Ringholm and L. Kelstrup declare no competing interests.

RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Ringholm, L., Mathiesen, E., Kelstrup, L. _et al._ Managing type 1 diabetes mellitus in pregnancy—from

planning to breastfeeding. _Nat Rev Endocrinol_ 8, 659–667 (2012). https://doi.org/10.1038/nrendo.2012.154 Download citation * Published: 11 September 2012 * Issue Date: November 2012 * DOI:

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