Vascular complications in the diabetic pregnancy.
Long-standing hyperglycemia frequently leads to vasculopathy. Microvascular disease is characterized by retinopathy and nephropathy, while macrovascular involvement can affect coronary arteries. Diabetic autonomic neuropathy, when present, is generally associated with retinal and/or renal involvement. Early identification of these diabetic complications allows appropriate counseling and early treatment. Among women with diabetic vasculopathy, nephropathy, chronic hypertension, preeclampsia, preterm delivery, and fetal growth restriction are frequently observed. Furthermore, women with impaired renal function in early pregnancy have increased risk of long-term deterioration of glomerular filtration rate. Proliferative retinopathy can progress during pregnancy and 1 year after delivery, but long-term effects are not likely to occur. When coronary artery disease or gastroparesis diabeticorum are present, excessive maternal and fetal morbidity is observed. When modern management is synchronized with early medical care, favorable maternal and perinatal outcomes can be expected.
Department of Obstetrics and Gynecology, High Risk Pregnancy Unit, Center for Medical Education and Clinical Research (C.E.M.I.C.), C.E.M.I.C. University, Av. Galvan 4089, CABA., CP1431, Buenos Aires, Argentina, gleguizamon@cemic.edu.ar.
Gustavo
G
Leguizamón
Denise
D
Trigubo
Juan Ignacio
JI
Pereira
María Fernanda
MF
Vera
José Alberto
JA
Fernández
D003925:Diabetic Angiopathies / Q000150:complications* / Q000453:epidemiology; D003928:Diabetic Nephropathies / Q000150:complications; D003930:Diabetic Retinopathy / Q000150:complications; D005260:Female; D006801:Humans; D010920:Placenta / Q000503:physiopathology; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000453:epidemiology / Q000473:pathology*; D011295:Prenatal Care