Retinopatía diabética y diabetes mellitus pregestacional: una mirada integral desde la oftalmología / Diabetic Retinopathy and Pregestational Diabetes Mellitus: a Comprehensive View from Ophthalmology

El incremento de la prevalencia de diabetes mellitus a nivel global en los últimos años la convierte en un desafío para los sistemas de salud. La retinopatía diabética como una de sus complicaciones crónicas más frecuentes se convierte en una de las principales causas de ceguera prevenible en el mundo, convirtiéndose el embarazo en un factor de riesgo importante para el desarrollo de esta enfermedad. El embarazo en mujeres con diagnóstico previo de diabetes mellitus, puede favorecer la aparición y la progresión de la retinopatía diabética. En esta etapa, las alteraciones metabólicas descritas de la diabetes mellitus se unen a las propias del embarazo con lo que el cuadro clínico se refuerza y acentúa, de hecho, se considera el mayor factor de riesgo y se asocia con un incremento en su prevalencia y gravedad. La presencia de retinopatía diabética no es una contraindicación para el embarazo, pero su diagnóstico y tratamiento precoz para prevenir la pérdida de visión, es esencial para preservar la calidad de vida de las gestantes previa y posterior al parto. La aparición y progresión de la retinopatía diabética en mujeres con diabetes mellitus pregestacional, se puede prevenir o reducir con una adecuada atención preconcepcional, un riguroso seguimiento clínico durante el embarazo y un temprano tratamiento, contribuyendo así a evitar la pérdida visual por esta causa(AU)

The increase in the prevalence of diabetes mellitus globally in recent years makes it a challenge for health systems. Diabetic retinopathy as one of its most frequent chronic complications has become one of the main causes of preventable blindness in the world, and pregnancy has become an important risk factor for the development of this disease. Pregnancy in women previously diagnosed with diabetes mellitus may favor the onset and progression of diabetic retinopathy. At this stage, the metabolic alterations described for diabetes mellitus are added to those of pregnancy itself, so that the clinical picture is reinforced and accentuated, in fact, it is considered the greatest risk factor and is associated with an increase in its prevalence and severity. The presence of diabetic retinopathy is not a contraindication for pregnancy, but its early diagnosis and treatment to prevent vision loss is essential to preserve the quality of life of pregnant women before and after delivery. The onset and progression of diabetic retinopathy in women with pregestational diabetes mellitus can be prevented or reduced with adequate preconception care, rigorous clinical follow-up during pregnancy and early treatment, thus helping to prevent visual loss due to this cause(AU)

The situation and feature of the intensive insulin therapy in a group of hyperglycemic patients during pregnancy / 中华内分泌代谢杂志

Relevant clinical data of 141 cases diagnosed pregestational diabetes mellitus(PGDM),diabetes mellitus in pregnancy(DIP), gestational diabetes mellitus(GDM), and type 2 diabetes mellitus(T2DM) were collected. The blood glucose control rate,insulin dose,and episode of hypoglycemia in the insulin intensive therapy were retrospectively analyzed. The results showed that there was no significant difference in the control rate among the four groups(P=0.906). The insulin dose/weight in GDM was significantly lower than those in PGDM,DIP,and T2DM groups[0.65(0.47-1.00),0.67(0.38-1.05),0.65(0.52-0.82)vs 0.45(0.29-0.61)U·kg-1·d-1,P<0.05 or P<0.01]. There was no significant difference in episode or incidence rate of hypoglycemia among the overall four groups(P=0.339). However in the patients with blood glucose reaching the control standard,the rate of hypoglycemia in T2DM was significantly higher than those in PGDM,DIP,and GDM(P<0.05 or P<0.01).

Progress of pregestational diabetes mellitus and congenital heart defects / 国际儿科学杂志

Pregestational diabetes mellitus may cause fetal heart defects,and it is considered to be an important non-genetic risk factors for congenital heart defects. However, the pathogenesis is unclear. Recent studies have shown that hyperglycemia, which acts as a primary teratogen in pregestational diabetes mellitus, may affect the endocardial cushion formation and neural crest cell development. Cardiac oxidative stress damage, increased myocardial cell apoptosis,increased synthesis of extracellular matrix, as well as the alteration of heart development-related genes expression are important pathogenic mechanism. In this paper, we review the progress in the effect and the pathogenesis of pregestational diabetes mellitus on heart development.

Clinical Study of Maternal and Perinatal Complication in Pregnancy with Diabetes Mellitus / 대한산부인과학회잡지

OBJECTIVES: The aim of the current paper is to analyze maternal and neonatal complication of pregestational diabetes mellitus and gestational diabetes mellitus, and to compare with the outcome METHOD: The study included 108 pregnancies with diabetes mellitus among 8,495 admitted to the Department of Obstetrics and Gynecology, Catholic University of Korea Medical College, Holy Family Hospital from January 1, 1995 to December 31, 1998. The pregnancies were divided into pregestational diabetes mellitus group and gestational diabetes mellitus group. The data were analyzed and reviewed retrospectively based on medical records RESULTS: 1) Incidence of maternal complication in gestational diabetes mellitus was 7% of pregnancy induced hypertension, 3% of pyelonephritis, 1% of retinopathy and 1% of chronic hypertension. In case of pregestational diabetes mellitus, 18% of pregnancy induced hypertension, 5% of nephropathy, 9% of retinopathy and 14% of pyelonephritis. 2) Incidence of neonatal complication in gestational diabetes mellitus was 1% of congenital malformation, 1% of shoulder dystorcia, 7.3% of polyhydramnios, 17.7% of hyperbilirubinemia, 40.6% of hypoglycemia and 1% of FDIU. In case of pregestaional diabetes mellitus, 1% of congenital malformation, 18.2% of polyhydramnios, 22.7% of hyperbilirubinemia, 27.3% of hypoglycemia, 18.6% of RDS and 4.6% of FDIU. 3) The outcomes of the treatment of pregestational diabetes; There was no significant difference in the maternal weight gain, neonatal birth wight but the incidence rates of neonatal complication was lower in case of insulin treatment 4) The outcomes of the treatment of gestational diabetes; There was significant difference in the maternal weight gain, neonatal birth weight and the incidence rates of maternal and neonatal complication was decreased in case of treatment. CONCLUSION: Incidence of maternal complication and perinatal complication was higher in pregestaional diabetes mellitus compared with gestational diabetes mellitus, so strict control of blood glucose level and education for diabetes mellitus were essential before gestation. And the proper treatment of gestational DM was necessary because maternal weight gain during pregnancy, neonatal birth weight and the maternal and neonatal complication were affected by treatment.