This talk will include clinical information of importance for clinical care during pregnancy of late diabetic complications as diabetic nephropathy, retinopathy and neuropathy.
Among diabetic pregnant women, the worst pregnancy outcome is seen in the subgroup of women with diabetic nephropathy. Development of signs of severe preeclampsia very early in pregnancy, often leading to very early preterm delivery, is frequent. The study of pathophysiologic mechanisms and observational studies support the beneficial of antihypertensive treatment to pregnant women with microalbuminuria or diabetic nephropathy in preventing preeclampsia and early preterm delivery.
Pregnancy is associated with increased risk of progression of retinopathy to sight-threatening retinopathy as proliferative retinopathy or macula edema in both type 1 and type 2 diabetes. The level of both circulating and local growth factors might be involved in the pathophysiology of this deterioration of retinopathy during pregnancy. In early pregnancy, poor glycemic control, elevated blood pressure and presence of moderate to severe retinopathy are associated with the risk of progression to sight-threatening retinopathy. Appropriate tailored screening for progression of retinopathy during pregnancy is needed. Macular edema can be successfully treated with intraocular injection of glucocorticoid during pregnancy.
Persistent nausea and vomiting during pregnancy might be related to diabetic autonom neuropathy and the worst cases can be treated with parental nutrition.
In conclusion, microvascular complications in pregnant women with pre-existing diabetes needs to be, screened for and, treated if necessary.