Diabetes and Pregnancy: findings of a multicenter Italian Study
Pregnancy is always a fascinating event in the life of the woman, of the couple, and of the environment around them, becoming an experience that is not only physical and biological, but that also extends to the mental, emotional and intellectual spheres.
Its physiological course can be compromised by preexisting diseases, diagnosed before the pregnancy or occurring during its course.
This is the case of diabetes mellitus, which complicates 3-5% of all pregnancies, fostered by a positive familiar predisposition for the disease, and/or by the more advanced age in which the first child is planned, as well as by diabetogenic effect, peculiar to the gestational state, where, on one hand, there is a physiological reduction in glucose tolerance, and, on the other, there is a progressive increase in insulin resistance. There are two types of diabetes occurring during pregnancy: preexisting (diabetes types I and II), and gestational.
In women with the pre-existing form, proper planning and maintenance of normal blood sugar levels are rewarded with significant reduction of miscarriages, malformation pathologies, fetal-neonatal mortality, and fetal macrosomia. In reality only 37% of women plan their pregnancy, and only 39% of them take folic acid in the periconceptional period.
Screening the unaffected population with obvious risk factors (ethnicity, family history, age, obesity, polycystic ovary syndrome, previous gestational diabetes, previous fetal macrosomia and / or polyamnios, excessive weight gain during pregnancy) is strongly recommended.
The results of the DAWN Study (Diabetes Attitudes Wishes and Needs), coordinated by Dr. Di Cianni, which is the first instance of a national and international specific investigation in diabetes and pregnancy, realized through the important contribution made by the patients themselves through an auto-filled questionnaires on the degree of satisfaction of the management of their obstetric complications at centers aimed at their management, identifying critical areas in the path of healing, were recently published.
These centers are born with the aim of promoting maternal and child health, by educating and informing on possible implications and complications, and by establishing timely and effective treatment regimens.
The conclusive data of this survey evidenced an increase in the number of diagnosed cases, due in part by the immigration of women from countries with higher incidence of diabetes, a reduction in adverse events thanks to the appropriate treatment setting, a scarcity of centers with multidisciplinary approach (gynecologist, internist, diabetologist, nutritionist, neonatologist) in the national territory, the identification of the risk of emergence of type II forms and the early recruitment of healthy lifestyles, and the need to implement the network of care throughout the territory developing nationally shared protocols.
Bibliography
-American College of Obstetrics and Gynecologists. Committee on Practice Bulletins. ACOG practice bulletin: clinical management guidelines for obstetrician-Gynecologists: No. 30. September 2001. Obstet Gynecol, 98:525-38, 2001
-American Diabetes Association-Position Statement. Gestational Diabetes. Diabetes Care, 27: S88-S90, 2004
-Bonomo M, Lapolla A, Mannino D et al. Diabetes in pregnancy care in Italy: structural and Organizative aspects. Diabetic Med 23 (3) :379-80, 2008
-DAWN Study Italy. Diabetes in pregnancy. 2009
Stefania Triunfo
Department of Women and Fetal Healthcare
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