Maternal problems (morbidity) associated with diabetes during pregnancy

Diabetes is a condition which can affect any system. Therefore monitoring of functions of all the systems is important to detect the problems. But common maternal problems are as follows;
1. Diabetic retinopathy
2. Deterioration of renal functions
3. Chronic hypertension
4. Preeclampsia


Diabetic retinopathy

This is one of the major causes of blindness in women in reproductive age group. Degree of retinal damage depends on the type of diabetes, duration of diabetes and glycemic control. Patients with preexisting diabetes have a higher risk than that of patients with gestational diabetes. A prospective study showed that while half the patients with preexisting retinopathy experienced deterioration during pregnancy, all the patients had partial regression following delivery and returned to their prepregnant state by 6 months postpartum. However, when the total effect of pregnancy on ophthalmologic status was considered, pregnant women had a slower progression of retinopathy than nonpregnant women.

Deterioration of renal function

Degree of renal damage depends on the type of diabetes, duration of diabetes and glycemic control. Patients with preexisting diabetes have a higher risk than that of patients with gestational diabetes. If there is preexisting renal damage, patient will have varying degree of deterioration of renal function during pregnancy as renal blood flow and the glomerular filtration rate increase 30-50% during pregnancy, the degree of proteinuria also increases. The most recent studies indicate that pregnancy does not measurably alter the time course of diabetic renal disease and it does not increase the likelihood of progression to end-stage renal disease.
Perinatal complications are greatly increased in patients with diabetic nephropathy. Preterm birth, intrauterine growth restriction, and preeclampsia are all significantly more common in women with diabetic nephropathy during pregnancy.


Chronic hypertension
About 10% of diabetic pregnancies are complicated with chronic hypertension. . Patients with underlying renal or retinal vascular disease are at a substantially higher risk. The risk of Intra Uterine growth Restriction (IUGR), preeclampsia, placental abruption and maternal stroke are high when the diabetes and chronic hypertension co-exist.
Preeclampsia
Preeclampsia is a clinical syndrome (collection of signs and symptoms). Abrupt elevation in blood pressure, significant proteinuria, and elevated uric acids level, evidence of hemolysis, elevated liver enzymes and low platelet count are the features of preeclampsia. The frequency of preeclampsia is higher when the pregnancy is complicated with diabetes.