СOMPLICATIONS OF PREGNANCY IN WOMEN WITH DIABETES MELLITUS AND POSSIBILITIES OF THEIR CORRECTION

Cover Page


Cite item

Full Text

Abstract

Reproductive disorders in women with pre-gestational diabetes mellitus lead not only to poorer fertility, but to complicated course and poor outcomes of pregnancy for mother and fetus. Compared to general population, patients with pre-gestational diabetes mellitus have higher frequencies of ovulation delay, ovarian dysfunction and infertility, and if they become diabetic before their puberty, they have later menarche and earlier menopause. All this is caused by functional disorders of hypothalamic-hypophyseal-adrenal axis and ovarian insufficiency with significant decrease in progesterone levels. Pre-conceptional existence of diabetes mellitus is associated with high probability of menstrual cycle disorders, infertility, and in case of pregnancy – with its complicated course (congenital malformations, miscarriage, fetoplacental insufficiency, pre-eclampsia). The risk of these abnormalities is increased in case of late diabetic complications and poor glucose control. Babies born to diabetic mothers, beyond fetopathy and fetoplacental insufficiency, suffer from long term central nervous system disorders that may lead to problems in social adaptation. 

There are no effective treatments for advanced clinical pre-eclampsia and uncontrolled fetoplacental insufficiency that necessitates the pregnancy to be terminated in the interests of mother or fetus. Due to this, in women with pre-gestational diabetes it is reasonable to implement preventive measures including those aimed at the main components of pathophysiology of a number of obstetric complications. In particular, to correct potential complications of pregnancy in women with diabetes mellitus, administration of active forms of folinic acid and normalization of eicosanoid balance with oral polyunsaturated ω-3 fatty acids is indicated during pregnancy planning and during gestation. 

About the authors

V. M. Gur'eva

Moscow Regional Scientific Research Institute for Obstetrics and Gynecology

Author for correspondence.
Email: helgin99@gmail.com

MD, PhD, Leading Research Fellow, Department of Physiological Obstetrics

Россия

F. F. Burumkulova

Moscow Regional Scientific Research Institute for Obstetrics and Gynecology

Email: fake@neicon.ru

MD, PhD, Senior Research Fellow, Therapeutic Group

Россия

T. S. Budykina

Moscow Regional Scientific Research Institute for Obstetrics and Gynecology

Email: fake@neicon.ru

MD, PhD, Head of Clinical Diagnostic Laboratory

Россия

L. S. Morokhotova

Moscow Regional Scientific Research Institute for Obstetrics and Gynecology

Email: fake@neicon.ru

Postgraduate Student, Department of Physiological Obstetrics

Россия

T. A. Buyvalo

Naro-Fominsk District Hospital No. 1

Email: fake@neicon.ru
Obstetrician/Gynaecologist Россия

References

  1. Pregnancy outcomes in the Diabetes Control and Complications Trial. Am J Obstet Gynecol. 1996;174(4):1343–53.
  2. Evers IM, Bos AM, Aalders AL, van Ballegooie E, de Valk HW, van Doormaal JJ, ter Brugge HG, Visser GH. Pregnancy in women with diabetes mellitus type I: maternal and perinatal complications, in spite of good blood glucose control. Ned Tijdschr Geneeskd. 2000;144(17):804–9.
  3. Gabbe SG, Holing E, Temple P, Brown ZA. Benefits, risks, costs, and patient satisfaction associated with insulin pump therapy for the pregnancy complicated by type 1 diabetes mellitus. Am J Obstet Gynecol. 2000;182(6):1283–91.
  4. Григорян ОР, Шереметьева ЕВ, Андреева ЕН. Сахарный диабет и беременность. М.: Видар; 2011. 145 с. (Grigoryan OR, Sheremet'eva EV, Andreeva EN. Diabetes mellitus and pregnancy. Moscow: Vidar; 2011. 145 p. Russian).
  5. Vinceti M, Malagoli C, Rothman KJ, Rodolfi R, Astolfi G, Calzolari E, Puccini A, Bertolotti M, Lunt M, Paterlini L, Martini M, Nicolini F. Risk of birth defects associated with maternal pregestational diabetes. Eur J Epidemiol. 2014;29(6):411–8.
  6. Дедов ИИ, Фадеев ВВ. Введение в диабетологию. Руководство для врачей. М.: Берег; 1998. 199 с. (Dedov II, Fadeev VV. Introduction in diabetology: guidance for physicians. Moscow: Bereg; 1998. 199 p. Russian).
  7. Дедов ИИ, Шестакова МВ, Максимова МА. Федеральная целевая программа «Сахарный диабет». Методические рекомендации. М.; 2007. 134 c. (Dedov II, Shestakova MV, Maksimova MA. Federal targeted programme “Diabetes mellitus”. Guidance for physicians. Moscow; 2007. 134 p. Russian).
  8. Wahabi HA, Alzeidan RA, Esmaeil SA. Pre-pregnancy care for women with pregestational diabetes mellitus: a systematic review and meta-analysis. BMC Public Health. 2012;12:792.
  9. Diabetes Control and Complications Trial Research Group. Effect of pregnancy on microvascular complications in the diabetes control and complications trial. The Diabetes Control and Complications Trial Research Group. Diabetes Care. 2000;23(8):1084–91.
  10. Simpson SH, Corabian P, Jacobs P, Johnson JA. The cost of major comorbidity in people with diabetes mellitus. CMAJ. 2003;168(13):1661–7.
  11. Hellmuth E, Damm P, Molsted-Pedersen L, Bendtson I. Prevalence of nocturnal hypoglycemia in first trimester of pregnancy in
  12. patients with insulin treated diabetes mellitus. Acta Obstet Gynecol Scand. 2000;79(11):958–62.
  13. Sibai BM, Caritis S, Hauth J, Lindheimer M, VanDorsten JP, MacPherson C, Klebanoff M, Landon M, Miodovnik M, Paul R, Meis P, Dombrowski M, Thurnau G, Roberts J, McNellis D. Risks of preeclampsia and adverse neonatal outcomes among women with pregestational diabetes mellitus. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Am J Obstet Gynecol. 2000;182(2):364–9.
  14. Temple RC, Aldridge V, Stanley K, Murphy HR. Glycaemic control throughout pregnancy and risk of pre-eclampsia in women with type I diabetes. BJOG. 2006;113(11):1329–32.
  15. Sullivan SD, Umans JG, Ratner R. Hypertension complicating diabetic pregnancies: pathophysiology, management, and controversies. J Clin Hypertens (Greenwich). 2011;13(4):275–84.
  16. Hiilesmaa V, Suhonen L, Teramo K. Glycaemic control is associated with pre-eclampsia but not with pregnancy-induced hypertension in women with type I diabetes mellitus. Diabetologia. 2000;43(12):1534–9.
  17. Sato T, Sugiyama T, Kurakata M, Saito M, Sugawara J, Yaegashi N, Sagawa N, Sanaka M, Akazawa S, Anazawa S, Waguri M,Sameshima H, Hiramatsu Y, Toyoda N; Japan Diabetes and Pregnancy Study Group. Pregnancy outcomes in women with type 1 and type 2 diabetes mellitus in a retrospective multi-institutional study in Japan. Endocr J. 2014;61(8):759–64.
  18. Weissgerber TL, Gandley RE, Roberts JM, Patterson CC, Holmes VA, Young IS, McCance DR; Diabetes and Pre-eclampsia Intervention Trial (DAPIT) Study Group. Haptoglobin phenotype, pre-eclampsia, and response to supplementation with vitamins C and E in pregnant women with type-1 diabetes. BJOG. 2013;120(10):1192–9.
  19. Евсюкова ИИ, Кошелева НГ. Сахарный диабет: беременные и новорожденные. СПб.: Специальная литература; 1996. 268 с. (Evsyukova II, Kosheleva NG. Diabetes mellitus: gravidae and newborns. Saint Petersburg: Spetsial'naya literatura; 1996. 268 p. Russian).
  20. Морохотова ЛС, Сидорова АА, Гурьева ВМ, Бурумкулова ФФ. Гипертензивные осложнения у беременных с сахарным диабетом. В: Сборник тезисов. VI Всероссийский конгресс эндокринологов; Москва, 27–31 мая 2012 г. М.; 2012. с. 156. (Morokhotova LS, Sidorova AA, Gur'eva VM, Burumkulova FF. Hypertensive complications in pregnant women with diabetes mellitus. In: Abstract compendium, VI Russian Congress of Endocrinologists; 2012 May 27–31; Moscow, Russia. Мoscow; 2012. p. 156. Russian).
  21. Haeri S, Khoury J, Kovilam O, Miodovnik M. The association of intrauterine growth abnormalities in women with type 1 diabetes mellitus complicated by vasculopathy. Am J Obstet Gynecol. 2008;199(3):278.e1–5.
  22. Gordin D, Forsblom C, Groop PH, Teramo K, Kaaja R. Risk factors of hypertensive pregnancies in women with diabetes and
  23. the influence on their future life. Ann Med. 2014;46(7):498–502.
  24. Hanson U, Persson B. Epidemiology of pregnancyinduced hypertension and preeclampsia in type 1 (insulin-dependent) diabetic pregnancies in Sweden. Acta Obstet Gynecol Scand. 1998;77(6):620–4.
  25. Cundy T, Slee F, Gamble G, Neale L. Hypertensive disorders of pregnancy in women with Type 1 and Type 2 diabetes. Diabet Med. 2002;19(6):482–9.
  26. Сюндюкова ЕГ, Медведев БИ, Сашенков СЛ, Квятковская СВ, Дворчик ЕЕ, Шестакова ЕВ. Значение гомоцистеина и полиморфизма гена MTHFRC677T в развитии преэклампсии. Вестник Уральской медицинской академической науки. 2014;(1):23–6. (Syundyukova EG, Medvedev BI, Sashenkov SL, Kvyatkovskaya SV, Dvorchik EE, Shestakova EV. [The value of homocysteine and Mthfr C677t polymorphism in the development of preeclampsia]. Vestnik Ural'skoy meditsinskoy akademicheskoy nauki. 2014;(1):23–6. Russian).
  27. Гурьева ВА, Костькина ЯМ. Прогностические факторы перинатального риска у женщин с приобретенной и наследственной гипергомоцистеинемией. Современные проблемы науки и образования. 2012;(4). Available from: http://www.science-education.ru/1046675. (Gur'eva VA, Kost'kina YaM. [Predictors of perinatal risk in women with acquired and hereditary hyperhomocusteinemia]. Sovremennye problemy nauki i obrazovaniya. 2012;(4). Available from: http://www.science-education.ru/104-6675. Russian).
  28. Streppel MT, Ocke MC, Boshuizen HC, Kok FJ, Kromhout D. Long-term fish consumption and n-3 fatty acid intake in relation to (sudden) coronary heart disease death: the Zutphen study. Eur Heart J. 2008;29(16):2024–30.
  29. Федорова МВ, Краснопольский ВИ, Петрухин ВА. Сахарный диабет, беременность и диабетическая фетопатия. М.: Медицина; 2001. 292 c. (Fedorova MV, Krasnopol'skiy VI, Petrukhin VA. Diabetes mellitus, pregnancy and diabetic fetopathy. Moscow: Meditsina; 2001. 292 p. Russian).
  30. Троицкая МВ, Аксенов АН, Башакин НФ. Особенности ранней постнатальной адаптации новорожденных, родившихся у матерей с сахарным диабетом. Российский вестник акушера-гинеколога. 2003;(3):44–8. (Troitskaya MV, Aksenov AN, Bashakin NF. [Early postnatal adaptation in neonates born by mothers with diabetes mellitus]. Rossiyskiy vestnik akushera-ginekologa. 2003;(3):44–8. Russian).
  31. Аксенов АН, Троицкая МВ, Башакин НФ, Мусорина ЛН. Современные принципы проведения интенсивной терапии новорожденным с диабетической фетопатией. Международный журнал медицинской практики. 2000;(6):71–3. (Aksenov AN, Troitskaya MV, Bashakin NF, Musorina LN. [Current principles of intensive therapy of newborns with diabetic fetopathy]. Mezhdunarodnyy zhurnal meditsinskoy praktiki. 2000;(6):71–3. Russian).
  32. Краснопольский ВИ, Бурумкулова ФФ, Нестеренко ОС, Логутова ЛС, Будыкина ТС, Петрухин ВА, Аксенов АН, Башакин НФ, Троицкая МВ, Витушко СА, Котов ЮБ, Шидловская НВ. Динамическое наблюдение за детьми, родившимися у матерей с различной эндокринной патологией. Российский вестник акушера-гинеколога. 2005;(1):74–80. (Krasnopol'skiy VI, Burumkulova FF, Nesterenko OS, Logutova LS, Budykina TS, Petrukhin VA, Aksenov AN, Bashakin NF, Troitskaya MV, Vitushko SA, Kotov YuB, Shidlovskaya NV. [A followup of children born by mothers with different endocrine pathology]. Rossiyskiy vestnik akushera-ginekologa. 2005;(1):74–80. Russian).
  33. Полетаев АБ, Вабищевич НК, Гнеденко ББ, Будыкина ТС, Петрухин ВА, Котов ЮБ, Федорова МВ, Демин ВФ. О возможных механизмах нарушения развития нервной системы ребенка при диабетической фетопатии. Вестник Российской ассоциации акушеров-гинекологов. 1998;(3):31–5.(Poletaev AB, Vabishchevich NK, Gnedenko BB, Budykina TS, Petrukhin VA, Kotov YuB, Fedorova MV, Demin VF. [On potential mechanisms of developmental disorders of the nervous system in a baby with diabetic fetopathy]. Vestnik Rossiyskoy assotsiatsii akusherov-ginekologov. 1998;(3):31–5. Russian).
  34. Проценко АМ, Будыкина ТС, Морозов СГ, Рыбаков АС, Грибова ИЕ, Проценко АН. Перинатальные исходы у беременных с сахарным диабетом с различным содержанием аутоантител к инсулину и его рецепторам. Патологическая физиология и экспериментальная терапия. 2010;(2): 17–23.
  35. (Protsenko AM, Budykina TS, Morozov SG, Rybakov AS, Gribova IE, Protsenko AN. [Perinatal outcomes in pregnant women with diabetes mellitus with various levels of autoantibodies to insulin and its receptors]. Patologicheskaya fiziologiya i eksperimental'naya terapiya. 2010;(2):17–23. Russian).

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2015 Gur'eva V.M., Burumkulova F.F., Budykina T.S., Morokhotova L.S., Buyvalo T.A.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies