Hypoglycaemia in Clinical Diabetes

232 HYPOGLYCAEMIA IN PREGNANCYMicrovascular Complications of PregnancyRetinopathy is common and may progress during pregnancy. Therefore retinal screeningshould be undertaken during each trimester (Figure 10.1). In the longer term, parous womenwith type 1 diabetes have significantly lower levels of all types of retinopathy comparedwith non-parous women. The associated significant differences in HbA 1c suggest that theimproved glycaemic control that is associated with pregnancy may be sustained over timewith beneficial effects on long-term complications. Thus women should be reassured thatstrict glycaemic control during, and immediately after, pregnancy can effectively reducethe long-term risk of retinopathy. In pregnancy, diabetic nephropathy of any degree is lesscommon than retinopathy, and requires specialist management.COMPLICATIONS IN THE INFANT OF THE DIABETIC MOTHERThe potential complications for the infant of a mother with diabetes are shown in Table 10.6.Newly born infants with diabetic mothers are at increased risk of developing hypoglycaemia.To avoid this risk, maternal blood glucose should be kept as close to normal as possibleduring pregnancy and particularly during labour and delivery. Early feeding of the newlyborn infant is essential and careful monitoring is mandatory.The Risks of Maternal Hypoglycaemia to the Fetus/infantThe potential risks of hypoglycaemia to the offspring can be considered in three main ways:the teratogenic effects of hypoglycaemia, other immediate effects on the fetus and delayedeffects.Table 10.6 Potential problems affecting the infant ofa mother with diabetesNeonatal and perinatal• Hypoglycaemia• Stillbirth• Increased perinatal mortality• Congenital anomalies• Preterm delivery• Macrosomia• Birth trauma at delivery• Polycythaemia• Respiratory distress syndrome