Rationale:

• Retinopathy and severe nephropathy may worsen during pregnancy.
• Hypertensive disorders frequently complicate diabetic pregnancies.
• Patients with neuropathy need increased counseling on the importance of foot care.
• There is a 5% to 10% coincidence of hyperthyroidism or hypothyroidism and type 1 diabetes.

Evidence:

• In a prospective study to determine the effects of pregnancy on diabetic retinopathy, pregnancy was associated with progression after adjustment for glycosylated hemoglobin measurements (P<0.005; adjusted OR, 2.3) (17).
• In a study of 31 continuous diabetic pregnancies of women with pregestational diabetes, 71% developed nephrotic range proteinuria. In all of these patients, proteinuria reverted to previous levels after delivery (16).
• In a case study of 311 diabetic pregnant women with proteinuria, 31% to 58% developed pre-eclampsia. The increased risk persisted after controlling for parity, chronic hypertension, retinopathy, and glycemic control (20).
• In a small, prospective study of women with type 1 diabetes, the incidence of postpartum thyroid disease was 25%, which is three times higher than a similar nondiabetic population (50).

Comments:

• None.