Skip to main content

Advertisement

SpringerLink
Log in

Management of Pregnant Women with Type 2 Diabetes Mellitus and the Consequences of Fetal Programming in Their Offspring

  • Diabetes and Pregnancy (CJ Homko, Section Editor)
  • Published:
Current Diabetes Reports Aims and scope Submit manuscript

Abstract

The obesity epidemic has fueled an epidemic of prediabetes and type 2 diabetes mellitus in women of childbearing age. This paper examines the state of the science on preconception and pregnancy management of women with type 2 diabetes to optimize outcomes for the women and their infants. In addition, the consequence of fetal programming as a result of suboptimal maternal glycemic control is discussed. The paper focuses on type 2 diabetes, not type 1 diabetes or gestational diabetes. Management of women with type 2 diabetes includes preconception counseling, preconception weight management and weight loss, proper weight gain during pregnancy, self-monitoring of blood glucose levels, medication, medical nutrition therapy, and exercise.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. American Diabetes Association. Standards of medical care in diabetes—2015. Diabetes Care. 2015;38 Suppl 1:S1–92. This reference gives an excellent overview of diabetes self-management.

  2. American Diabetes Association, Medical management of pregnancy complicated by diabetes. 5th ed, ed. D.R. Coustan. 2013; Alexandria: American Diabetes Association. This reference gives an excellent overview of diabetes self-management in pregnant women.

  3. Guariguata L et al. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Res Clin Pract. 2014;103:137–49. This reference gives projections for the future epidemic of diabetes globally.

  4. International Diabetes Federation. IDF diabetes atlas—2015. 7th ed. Brussels: International Diabetes Federation; 2015.

    Google Scholar 

  5. Castorino K, Jovamovic L. Pregnancy and diabetes management: advances and controversies. Clin Chem. 2011;57(2):221–30.

    Article  CAS  PubMed  Google Scholar 

  6. Yajnik CS. Fetal programming of diabetes: still so much to learn! Diabetes Care. 2010;33(5):1146–8.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Portha B, Chavey A, Movassat J. Early-life origins of type 2 diabetes: fetal programming of the beta-cell mass. Exp Diabetes Res. 2011;2011:1–14. Excellent reference on fetal programming.

    Google Scholar 

  8. Physicians’ desk reference. 70th ed. Montvale, NJ: PDR, LLC; 2016: 2084-2093.

  9. U.S. Department of Health and Human Services. Aim for a healthy weight. Bethesda, MD: U.S. Department of Health and Human Services; 2010. NIH Publication No. 10-7415.

    Google Scholar 

  10. Institute of Medicine. Weight gain during pregnancy: reexamining the guidelines. Washington, DC: National Academies Press; 2009.

    Google Scholar 

  11. American Diabetes Association. Management of diabetes in pregnancy: standards of medical care in diabetes—2015. Diabetes Care. 2015;38 Suppl 1:S77–9. Excellent reference on management of diabetes in pregnancy.

    Article  Google Scholar 

  12. Gallen IW, Jaap A, Roland JM, Chirayath HH. Survey of glargine use in 115 pregnant women with type 1 diabetes mellitus. Diabet Med. 2008;25:165–9.

    Article  CAS  PubMed  Google Scholar 

  13. Imbergamo MP, Amato MC, Sciortino G, Gambina M, Accidenti M, Criscimanna A, et al. Use of glargine in pregnant women with type 1 diabetes mellitus: a case-control study. Clin Ther. 2008;38:1476–89.

    Article  Google Scholar 

  14. Kurtzhals P et al. Correlations of receptor binding and metabolic and mitogenic potencies of insulin analogs designed for clinical use. Diabetes Care. 2000;49:999–1005.

    Article  CAS  Google Scholar 

  15. Jovanovic L, Druzin M, Peterson C. Effect of euglycemia on the outcome of pregnancy in insulin dependent diabetic women as compared with normal control subjects. Am J Med. 1981;71:921–7.

    Article  CAS  PubMed  Google Scholar 

  16. Goh JE, Sadler L, Rowan J. Metformin for gestational diabetes in routine clinical practice. Diabetes Med. 2011;28(9):1082–7.

    Article  CAS  Google Scholar 

  17. Mukherjee MS, Coppenrath VA, Dallinga BA. Pharmacologic management of types 1 and 2 diabetes mellitus and their complications in women of childbearing age. Pharmacotherapy. 2015;35(2):158–74.

    Article  CAS  PubMed  Google Scholar 

  18. Langer O et al. A comparison of glyburide and insulin in women with gestational diabetes mellitus. N Engl J Med. 2000;343(16):1134–8.

    Article  CAS  PubMed  Google Scholar 

  19. Langer O et al. Insulin and glyburide therapy: dosage, severity level of gestational diabetes, and pregnancy outcome. Am J Obstet Gynecol. 2005;192(1):134–9.

    Article  CAS  PubMed  Google Scholar 

  20. Kremer CJ, Duff P. Glyburide for the treatment of gestational diabetes. Am J Obstet Gynecol. 2004;190:1438–9.

    Article  CAS  PubMed  Google Scholar 

  21. Franz MJ, Evert A. American Diabetes Association guide to nutrition therapy for diabetes. 2nd ed. Alexandria, VA: American Diabetes Association; 2012.

    Google Scholar 

  22. The American College of Obstetricians and Gynecologists. Exercise during pregnancy and the postpartum period: ACOG committee opinion number 267. Washington, DC: The American College of Obstetricians and Gynecologists; 2002.

    Google Scholar 

  23. Harris GD, White RD. Diabetes management and exercise in pregnant patients with diabetes. Clinical Diabetes. 2005;23:165–8.

    Article  Google Scholar 

  24. Tomar AS et al. Intrauterine programming of diabetes and obesity. Curr Obes Rep. 2015;4(4):418–28.

    Article  PubMed  Google Scholar 

  25. Barua S, Junaid MA. Lifestyle, pregnancy and epigenetic effects. Epigenomics. 2015;7(1):85–102.

    Article  CAS  PubMed  Google Scholar 

  26. Eriksson JG. Epidemiology, genes and the environment: lessons learned from the Helsinki Birth Cohort Study. J Intern Med. 2007;261(5):418–25.

    Article  CAS  PubMed  Google Scholar 

  27. Calkins K, Devaskar SU. Fetal origins of adult disease. Curr Probl Pediatr Adolesc Health Care. 2011;41(6):158–76.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Moisiadis VG, Matthews SG. Glucocorticoids and fetal programming part 1: outcomes. Nat Rev Endocrinol. 2014;10:391–402.

    Article  CAS  PubMed  Google Scholar 

  29. Moisiadis VG, Matthews SG. Glucocorticoids and fetal programming part 2: mechanisms. Nat Rev Endocrinol. 2014;10:403–11.

    Article  CAS  PubMed  Google Scholar 

  30. Pedersen J, Osler M. Hyperglycemia as the cause of characteristic feature of the foetus and newborn of diabetic mothers. Dan Med Bull. 1961;8:78–83.

    CAS  PubMed  Google Scholar 

  31. Freinkel N. Of pregnancy and progeny. Diabetes. 1980;29:1023–35.

    Article  CAS  PubMed  Google Scholar 

  32. Hales CN et al. Fetal and infant growth and impaired glucose tolerance at age 64. BMJ. 1991;303:1019–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. McCance DR et al. Birth weight and non-insulin dependent diabetes: thrifty genotype, thrifty phenotype, or surviving small baby genotype? BMJ. 1994;308(6934):942–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Whincup PH et al. Birth weight and risk of type 2 diabetes: a systematic review. JAMA. 2008;300(24):2886–97.

    Article  CAS  PubMed  Google Scholar 

  35. Uribarri J et al. Restriction of advanced glycation end products improves insulin resistance in human type 2 diabetes: potential role of AGER1 and SIRT1. Diabetes Care. 2011;34(7):1610–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Tang Z et al. Placental Hofbauer cells and complications of pregnancy. Ann NY Acad Sci. 2011;1221:103–8.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Clausen TD et al. High prevalence of type 2 diabetes and pre-diabetes in adult offspring of women with gestational diabetes mellitus or type 1 diabetes: the role of intrauterine hyperglycemia. Diabetes Care. 2008;31(2):340–6.

    Article  PubMed  Google Scholar 

  38. HAPO Study Cooperative Research Group et al. Hypertensive and adverse pregnancy outcomes. N Engl J Med. 2008;358:1991–2002.

    Article  Google Scholar 

  39. Pettitt DJ et al. Maternal glucose at 28 weeks of gestation is not associated with obesity in 2-year-old offspring: the Belfast Hyperglycemia and Adverse Pregnancy Outcome (HAPO) family study. Diabetes Care. 2010;33(6):1219–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Lindsay RS et al. Programming of adiposity in offspring of mothers with type 1 diabetes at age 7 years. Diabetes Care. 2010;33:1080–5.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Gillman MW et al. Effect of treatment of gestational diabetes on obesity in the next generation. Diabetes Care. 2010;33:964–8.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Pirkola J et al. Risks of overweight and abdominal obesity at age 16 years associated with prenatal exposures to maternal prepregnancy overweight and gestational diabetes mellitus. Diabetes Care. 2010;33(5):1115–21.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

We thank our research assistants Sergio Eduardo Matίenzo Torres and Beatriz Medellίn Cabrera.

Author information

Authors and Affiliations

  1. School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7460, Chapel Hill, NC, 27599-7460, USA

    Diane C. Berry

  2. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, 3010 Old Clinic Building, CB#7516, Chapel Hill, NC, 27599-7516, USA

    Kim Boggess & Quinetta B. Johnson

Authors
  1. Diane C. Berry
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kim Boggess
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Quinetta B. Johnson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Diane C. Berry.

Ethics declarations

Conflict of Interest

Diane Berry, Kim Boggess, and Quinetta Johnson declare they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Diabetes and Pregnancy

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Berry, D.C., Boggess, K. & Johnson, Q.B. Management of Pregnant Women with Type 2 Diabetes Mellitus and the Consequences of Fetal Programming in Their Offspring. Curr Diab Rep 16, 36 (2016). https://doi.org/10.1007/s11892-016-0733-7

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11892-016-0733-7

Keywords

Search

Navigation