ABSTRACT
The association between diabetes during pregnancy and the risk of adverse maternal and fetal outcome is well established. Maternal complications include spontaneous abortions, preterm deliveries, preeclampsia, nephropathy, cesarean section, and among others birth trauma. Not only that improving glycemic control reduces the risk for adverse outcome in pregestational diabetes, but also in gestational diabetes mellitus (GDM), treatment and achieving desired level of glycemic status effectively diminishes the risk for complications. The most devastating adverse fetal outcome is perinatal mortality. Since GDM is expressed in the late second or early third trimester, which is beyond the period of fetal organogenesis, congenital anomalies are a complication of mainly preexisting diabetes. Metabolic complications include fetal hypoglycemia, polycythemia, hyperbilirubinemia, and hypocalcemia. The main contributor to metabolic complications is fetal hyperinsulinemia, which is also responsible for fetal macrosomia. Maternal hyperglycemia is associated with increased risk for adverse perinatal outcome with no single threshold that eliminates the risk for all adverse outcomes.
