Diabetes mellitus and pregnancy. Case contributions on the state of therapy
Gräni, R.; Ramzin, M.; Berger, W.
Schweizerische Medizinische Wochenschrift 112(5): 134-140
1982
ISSN/ISBN: 0036-7672 PMID: 7041254 Document Number: 193082
Modern means for monitoring and treatment of pregnant diabetics are demonstrated in 6 cases. To quantify the degree of diabetic control regular control of blood glucose profiles and determination of glycosylated hemoglobin (hemoglobin A1 or A1c) are required. Blood glucose measurements can be carried out by self-monitoring or by drawing blood samples and bringing them to the laboratory for analysis. To avoid fetal malformations and to protect the mother, normoglycemia should be obtained. If this goal cannot be reached by conventional insulin therapy with several single injections a day, the authors use a portable infusion pump for continuous subcutaneous infusion. This treatment is of particular importance in high risk patients with retinopathy and nephropathy. For fetal monitoring cardiotocography was the main method. Since the lecithin/sphingomyelin ratio of amniotic fluid is not always a reliable indicator of fetal lung maturity in diabetic pregnancies, the amniotic lecithin concentration is also measured. Estriol and HPL as indices of feto-placental function can be misleadingly high in plasma (or low in urine) in patients with impaired renal function. Optimal treatment of pregnant diabetics requires close collaboration with the obstetrician and the neonatal pediatrician.