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Endocrine Abstracts (2011) 26 S18.2

Alexandra Hospital, Athens, Greece.


Obesity and DM2 increasingly affect young adults worldwide, to the point of warranting the description of ‘epidemic’. This means that greater numbers of women of reproductive age are at risk. Frequently DM2 remains undiagnosed until pregnancy. The rate of congenital malformations seems to be the same with that of women with DM1, but the rate of perinatal mortality appears to be increased, according to a recent meta-analysis. These findings occur despite the fact that DM2 pregnant women have lower duration of disease, rate of complications and levels of HbA1c throughout pregnancy compared to DM1 women. The increased risk may be attributed to obesity, ethnicity, social deprivation and lack of preconception care. During pregnancy the management includes: i) self-monitoring of blood glucose in order to achieve the recommended glucose levels; ii) medical nutrition therapy, which has to be individualized taking into account the BMI; iii) exercise; iv) insulin. Most organizations do not recommend oral glucose lowering agents during pregnancy, because apart from the unknown long-term risks for progeny, it is difficult to achieve excellent glucose control in order to avoid fetal macrosomia. During labor maternal tight glucose control has to be maintained in order to prevent neonatal hypoglycemia. After delivery insulin requirements drop dramatically. Breastfeeding has to be encouraged. If required, metformin and possibly glibenclimide may be used. Finally, it is important to advise these women for the need to plan any future pregnancy.

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