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Managing type 1 diabetes mellitus in pregnancy—from planning to breastfeeding

Nature Reviews Endocrinology volume 8, pages 659–667 (2012)Cite this article

Subjects

Abstract

Type 1 diabetes mellitus in pregnant women increases the risk of adverse outcomes for mother and offspring. Careful preconception counselling and screening is important, with particular focus on glycaemic control, indications for antihypertensive therapy, screening for diabetic nephropathy, diabetic retinopathy and thyroid dysfunction, as well as review of other medications. Supplementation with folic acid should be initiated before conception in order to minimize the risk of fetal malformations. Obtaining and maintaining tight control of blood glucose and blood pressure before and during pregnancy is crucial for optimizing outcomes; however, the risk of severe hypoglycaemia during pregnancy is a major obstacle. Although pregnancy does not result in deterioration of kidney function in women with diabetic nephropathy and normal serum creatinine levels, pregnancy complications such as pre-eclampsia and preterm delivery are more frequent in these women than in women with T1DM and normal kidney function. Rapid-acting insulin analogues are considered safe to use in pregnancy and studies on long-acting insulin analogues have provided reassuring results. Immediately after delivery the insulin requirement declines to approximately 60% of the prepregnancy dose, and remains 10% lower than before pregnancy during breastfeeding.

Key Points

  • Tight maternal glycaemic and blood pressure control is crucial, and hypoglycaemia must be avoided during pregnancy

  • Insulin analogues can be used before and during pregnancy

  • Folic acid supplementation should be initiated before conception and continued to the end of the first trimester

  • Maternal screening for retinopathy and nephropathy should be carried out

  • Close surveillance of fetus and newborn baby is important

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Figure 1: Hypoglycaemic events in pregnancy.
Figure 2: Preterm delivery related to urinary albumin excretion in type 1 diabetes mellitus.

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References

  1. Boulot, P. et al. French multicentric survey of outcome of pregnancy in women with pregestational diabetes. Diabetes Care 26, 2990–2993 (2003).

    Article  PubMed  Google Scholar 

  2. Casson, I. F. et al. Outcomes of pregnancy in insulin dependent diabetic women: results of a five year population cohort study. BMJ 315, 275–278 (1997).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Confidential Enquiry into Maternal and Child Health. Pregnancy in Women with Type 1 and Type 2 Diabetes in 2002–3, England, Wales and Northern Ireland (CEMACH, London, 2005).

  4. Evers, I. M., de Valk, H. W. & Visser, G. H. Risk of complications of pregnancy in women with type 1 diabetes: nationwide prospective study in the Netherlands. BMJ 328, 915 (2004).

    Article  PubMed  PubMed Central  Google Scholar 

  5. Hawthorne, G. et al. Prospective population based survey of outcome of pregnancy in diabetic women: results of the Northern Diabetic Pregnancy Audit, 1994. BMJ 315, 279–281 (1997).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Jensen, D. M. et al. Outcomes in type 1 diabetic pregnancies: a nationwide, population-based study. Diabetes Care 27, 2819–2823 (2004).

    Article  PubMed  Google Scholar 

  7. Lapolla, A. et al. Outcome of pregnancy in type 1 diabetic patients treated with insulin lispro or regular insulin: an Italian experience. Acta Diabetol. 45, 61–66 (2008).

    Article  CAS  PubMed  Google Scholar 

  8. Macintosh, M. C. et al. Perinatal mortality and congenital anomalies in babies of women with type 1 or type 2 diabetes in England, Wales, and Northern Ireland: population based study. BMJ 333, 177 (2006).

    Article  PubMed  PubMed Central  Google Scholar 

  9. Penney, G. C., Mair, G. & Pearson, D. W. Outcomes of pregnancies in women with type 1 diabetes in Scotland: a national population-based study. BJOG 110, 315–318 (2003).

    Article  PubMed  Google Scholar 

  10. Platt, M. J. et al. St Vincent's Declaration 10 years on: outcomes of diabetic pregnancies. Diabet. Med. 19, 216–220 (2002).

    Article  CAS  PubMed  Google Scholar 

  11. Yang, J., Cummings, E. A., O'Connell, C. & Jangaard, K. Fetal and neonatal outcomes of diabetic pregnancies. Obstet. Gynecol. 108, 644–650 (2006).

    Article  PubMed  Google Scholar 

  12. Lapolla, A. et al. A multicenter Italian study on pregnancy outcome in women with diabetes. Nutr. Metab. Cardiovasc. Dis. 18, 291–297 (2008).

    Article  PubMed  Google Scholar 

  13. Persson, M., Norman, M. & Hanson, U. Obstetric and perinatal outcomes in type 1 diabetic pregnancies: A large, population-based study. Diabetes Care 32, 2005–2009 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  14. Boney, C. M., Verma, A., Tucker, R. & Vohr, B. R. Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics 115, e290–e296 (2005).

    Article  PubMed  Google Scholar 

  15. Esakoff, T. F., Cheng, Y. W., Sparks, T. N. & Caughey, A. B. The association between birthweight 4000 g or greater and perinatal outcomes in patients with and without gestational diabetes mellitus. Am. J. Obstet. Gynecol. 200, 672–674 (2009).

    Article  PubMed  Google Scholar 

  16. Schaefer-Graf, U. M. et al. Birth weight and parental BMI predict overweight in children from mothers with gestational diabetes. Diabetes Care 28, 1745–1750 (2005).

    Article  PubMed  Google Scholar 

  17. Vohr, B. R., McGarvey, S. T. & Tucker, R. Effects of maternal gestational diabetes on offspring adiposity at 4–7 years of age. Diabetes Care 22, 1284–1291 (1999).

    Article  CAS  PubMed  Google Scholar 

  18. Hod, M. et al. Fetal and perinatal outcomes in type 1 diabetes pregnancy: a randomized study comparing insulin aspart with human insulin in 322 subjects. Am. J. Obstet. Gynecol. 198, 186–187 (2008).

    Article  CAS  PubMed  Google Scholar 

  19. Hernandez, T. L., Friedman, J. E., van Pelt, R. E. & Barbour, L. A. Patterns of glycemia in normal pregnancy: should the current therapeutic targets be challenged? Diabetes Care 34, 1660–1668 (2011).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Damm, P., Mathiesen, E., Clausen, T. D. & Petersen, K. R. Contraception for women with diabetes mellitus. Metab. Syndr. Relat. Disord. 3, 244–249 (2005).

    Article  PubMed  Google Scholar 

  21. Varughese, G. I., Chowdhury, S. R., Warner, D. P. & Barton, D. M. Preconception care of women attending adult general diabetes clinics—are we doing enough? Diabetes Res. Clin. Pract. 76, 142–145 (2007).

    Article  CAS  PubMed  Google Scholar 

  22. Mathiesen, E. R. & Damm, P. Pregnancy—pharmacological problems. in Pharmacotherapy of Diabetes: New Developments. (Ed. Mogensen, C. E.) 249–255 (Springer, New York, 2009).

    Google Scholar 

  23. Temple, R. C., Aldridge, V. J. & Murphy, H. R. Prepregnancy care and pregnancy outcomes in women with type 1 diabetes. Diabetes Care 29, 1744–1749 (2006).

    Article  PubMed  Google Scholar 

  24. Tieu, J., Middleton, P. & Crowther, C. A. Preconception care for diabetic women for improving maternal and infant health. Cochrane Database of Systematic Reviews 2010 Issue 12. Art No.: CD007776 http://dx.doi.org/10.1002/14651858.CD007776.pub2

  25. Murphy, H. R. et al. Effectiveness of a regional prepregnancy care program in women with type 1 and type 2 diabetes: benefits beyond glycemic control. Diabetes Care 33, 2514–2520 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  26. Inkster, M. E. et al. Poor glycated haemoglobin control and adverse pregnancy outcomes in type 1 and type 2 diabetes mellitus: systematic review of observational studies. BMC Pregnancy Childbirth, 6 30 (2006).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. International Diabetes Federation. Global Guidelines on Pregnancy and Diabetes [online] (2009).

  28. Guideline Development Group. Management of diabetes from preconception to the postnatal period: summary of NICE guidance. BMJ 336, 714–717 (2008).

  29. National Institute of Health and Clinical Excellence. Diabetes in pregnancy: management of diabetes and its complications from pre-conception to the post-natal period [online] (2008).

  30. Nielsen, L. R. et al. Hypoglycemia in pregnant women with type 1 diabetes: predictors and role of metabolic control. Diabetes Care 31, 9–14 (2008).

    Article  PubMed  Google Scholar 

  31. Wilson, R. D. et al. The use of folic acid for the prevention of neural tube defects and other congenital anomalies. J. Obstet. Gynaecol. Can. 25, 959–973 (2003).

    Article  PubMed  Google Scholar 

  32. Capel, I. & Corcoy, R. What dose of folic acid should be used for pregnant diabetic women? Diabetes Care 30, e63 (2007).

    Article  PubMed  Google Scholar 

  33. Bar, J., et al. Pregnancy outcome in patients with insulin dependent diabetes mellitus and diabetic nephropathy treated with ACE inhibitors before pregnancy. J. Pediatr. Endocrinol. Metab. 12, 659–665 (1999).

    Article  CAS  PubMed  Google Scholar 

  34. Cooper, W. O. et al. Major congenital malformations after first-trimester exposure to ACE inhibitors. N. Engl. J. Med. 354, 2443–2451 (2006).

    Article  CAS  PubMed  Google Scholar 

  35. Porta, M. et al. Exposure to candesartan during the first trimester of pregnancy in type 1 diabetes: experience from the placebo-controlled Diabetic Retinopathy Candesartan Trials. Diabetologia 54 1298–1303 (2011).

    Article  CAS  PubMed  Google Scholar 

  36. Li, D. K., Yang, C., Andrade, S., Tavares, V. & Ferber, J. R. Maternal exposure to angiotensin converting enzyme inhibitors in the first trimester and risk of malformations in offspring: a retrospective cohort study. BMJ 343, d5931 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  37. Shotan, A., Widerhorn, J., Hurst, A. & Elkayam, U. Risks of angiotensin-converting enzyme inhibition during pregnancy: experimental and clinical evidence, potential mechanisms, and recommendations for use. Am. J. Med. 96, 451–456 (1994).

    Article  CAS  PubMed  Google Scholar 

  38. Tabacova, S., Little, R., Tsong, Y., Vega, A. & Kimmel, C.A. Adverse pregnancy outcomes associated with maternal enalapril antihypertensive treatment. Pharmacoepidemiol. Drug. Saf. 12, 633–646 (2003).

    Article  CAS  PubMed  Google Scholar 

  39. Sibai, B. M. Chronic hypertension in pregnancy. Obstet. Gynecol. 100, 369–377 (2002).

    Article  PubMed  Google Scholar 

  40. Nielsen, L. R., Muller, C., Damm, P. & Mathiesen, E. R. Reduced prevalence of early preterm delivery in women with Type 1 diabetes and microalbuminuria—possible effect of early antihypertensive treatment during pregnancy. Diabet. Med. 23, 426–431 (2006).

    Article  CAS  PubMed  Google Scholar 

  41. Nielsen, L. R., Damm, P. & Mathiesen, E. R. Improved pregnancy outcome in type 1 diabetic women with microalbuminuria or diabetic nephropathy: effect of intensified antihypertensive therapy? Diabetes Care 32, 38–44 (2009).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Vestgaard, M. et al. Pregnancy-induced sight-threatening diabetic retinopathy in women with Type 1 diabetes. Diabet. Med. 27, 431–435 (2010).

    Article  CAS  PubMed  Google Scholar 

  43. Vestgaard, M., Nielsen, L. R., Rasmussen, A. K., Damm, P. & Mathiesen, E. R. Thyroid peroxidase antibodies in pregnant women with type 1 diabetes: impact on thyroid function, metabolic control and pregnancy outcome. Acta Obstet. Gynecol. Scand. 87, 1336–1342 (2008).

    Article  CAS  PubMed  Google Scholar 

  44. Haddow, J. E. et al. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N. Engl. J. Med. 341, 549–555 (1999).

    Article  CAS  PubMed  Google Scholar 

  45. Abalovich, M. et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society Clinical Practice Guideline. J. Clin. Endocrinol. Metab. 92, S1–S47 (2007).

    Article  CAS  PubMed  Google Scholar 

  46. Kitzmiller, J. L. et al. Managing preexisting diabetes for pregnancy: summary of evidence and consensus recommendations for care. Diabetes Care 31, 1060–1079 (2008).

    Article  CAS  PubMed  Google Scholar 

  47. Jovanovic, L. & Inturissi, M. Assessment of glycemic control. In Managing Preexisting Diabetes Mellitus for Pregnancy. (Ed. Kitzmiller, J. L.) 9–15 (American Diabetes Association, 2008).

    Google Scholar 

  48. Kerssen A, de Valk, H. W. & Visser, G. H. Do HbA1c levels and the self-monitoring of blood glucose levels adequately reflect glycaemic control during pregnancy in women with type 1 diabetes mellitus? Diabetologia 49, 25–28 (2006).

    Article  CAS  PubMed  Google Scholar 

  49. Garcia-Patterson, A. et al. Insulin requirements throughout pregnancy in women with type 1 diabetes mellitus: three changes of direction. Diabetologia 53, 446–451 (2010).

    Article  CAS  PubMed  Google Scholar 

  50. Mathiesen, E. R. et al. Insulin dose during glucocorticoid treatment for fetal lung maturation in diabetic pregnancy: test of an algorithm. Acta Obstet. Gynecol. Scand. 81, 835–839 (2002).

    Article  PubMed  Google Scholar 

  51. Murphy, H. R. et al. Effectiveness of continuous glucose monitoring in pregnant women with diabetes: randomised clinical trial. BMJ 337, a1680 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  52. Worm, D., Nielsen, L. R., Mathiesen, E. R. & Norgaard, K. Continuous glucose monitoring system with an alarm: a tool to reduce hypoglycemic episodes in pregnancy with diabetes. Diabetes Care 29, 2759–2760 (2006).

    Article  PubMed  Google Scholar 

  53. Mosca, A. et al. Reference intervals for hemoglobin A1c in pregnant women: data from an Italian multicenter study. Clin. Chem. 52, 1138–1143 (2006).

    Article  CAS  PubMed  Google Scholar 

  54. Nielsen, L. R. et al. HbA1c levels are significantly lower in early and late pregnancy. Diabetes Care 27, 1200–1201 (2004).

    Article  CAS  PubMed  Google Scholar 

  55. Mills, J. L. et al. Physiological reduction in fasting plasma glucose concentration in the first trimester of normal pregnancy: the diabetes in early pregnancy study. Metabolism 47, 1140–1144 (1998).

    Article  CAS  PubMed  Google Scholar 

  56. Lurie, S. & Danon, D. Life span of erythrocytes in late pregnancy. Obstet. Gynecol. 80, 123–126 (1992).

    CAS  PubMed  Google Scholar 

  57. Kerssen, A., de Valk, H. W. & Visser, G. H. Forty-eight-hour first-trimester glucose profiles in women with type 1 diabetes mellitus: a report of three cases of congenital malformation. Prenat. Diagn. 26, 123–127 (2006).

    Article  PubMed  Google Scholar 

  58. British Medical Association and Royal Pharmaceutical Society of Great Britain. British National Formulary. (London, 2006).

  59. FDA NovoLog label [online] (2008).

  60. FDA Humalog label [online] (2011).

  61. EMA Novolog label [online] (2009).

  62. EMA Humalog label. http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/000088/WC500050332.pdf (2006).

  63. Mathiesen, E. R. et al. Maternal glycemic control and hypoglycemia in Type 1 diabetic pregnancy: a randomized trial of insulin aspart versus human insulin in 322 pregnant women. Diabetes Care 30, 771–776 (2007).

    Article  CAS  PubMed  Google Scholar 

  64. Mathiesen, E. R. et al. Maternal efficacy and safety outcomes in a randomized, controlled trial comparing insulin detemir with NPH insulin in 310 pregnant women with type 1 diabetes. http://dx.doi.org/10.2337/dc11-2264

  65. FDA detemir label [online] (2005).

  66. Gallen, I. W., Jaap, A., Roland, J. M. & Chirayath, H. H. Survey of glargine use in 115 pregnant women with Type 1 diabetes. Diabet. Med. 25, 165–169 (2008).

    Article  CAS  PubMed  Google Scholar 

  67. Lapolla, A. et al. Use of insulin detemir in pregnancy: a report on 10 Type 1 diabetic women. Diabet. Med. 26, 1181–1182 (2009).

    Article  CAS  PubMed  Google Scholar 

  68. Poyhonen-Alho, M., Ronnemaa, T., Saltevo, J., Ekblad, U. & Kaaja, R. J. Use of insulin glargine during pregnancy. Acta Obstet. Gynecol. Scand. 86, 1171–1174 (2007).

    Article  PubMed  Google Scholar 

  69. Gabbe, S. G., Carpenter, L. B. & Garrison, E. A. New strategies for glucose control in patients with type 1 and type 2 diabetes mellitus in pregnancy. Clin. Obstet. Gynecol. 50, 1014–1024 (2007).

    Article  PubMed  Google Scholar 

  70. McCance, D. & Holmes, V. A. Insulin regimens in pregnancy in A practical Manual of Diabetes in Pregnancy 99–109 (Blackwell Publishing Ltd, Oxford, UK, 2010).

    Book  Google Scholar 

  71. Workgroup on Hypoglycaemia, American Diabetes Association. Defining and reporting hypoglycemia in diabetes: a report from the American Diabetes Association Workgroup on Hypoglycemia. Diabetes Care 28, 1245–1249 (2005).

  72. Rosenn, B. M., Miodovnik, M., Holcberg, G., Khoury, J. C. & Siddiqi, T. A. Hypoglycemia: the price of intensive insulin therapy for pregnant women with insulin-dependent diabetes mellitus. Obstet. Gynecol. 85, 417–422 (1995).

    Article  CAS  PubMed  Google Scholar 

  73. Kimmerle, R., Heinemann, L., Delecki, A. & Berger, M. Severe hypoglycemia incidence and predisposing factors in 85 pregnancies of type I diabetic women. Diabetes Care 15, 1034–1037 (1992).

    Article  CAS  PubMed  Google Scholar 

  74. Leinonen, P. J., Hiilesmaa, V. K., Kaaja, R. J. & Teramo, K. A. Maternal mortality in type 1 diabetes. Diabetes Care 24, 1501–1502 (2001).

    Article  CAS  PubMed  Google Scholar 

  75. Evers, I. M. et al. Risk indicators predictive for severe hypoglycemia during the first trimester of type 1 diabetic pregnancy. Diabetes Care 25, 554–559 (2002).

    Article  PubMed  Google Scholar 

  76. Robertson, H., Pearson, D. W. & Gold, A. E. Severe hypoglycaemia during pregnancy in women with Type 1 diabetes is common and planning pregnancy does not decrease the risk. Diabet. Med. 26, 824–826 (2009).

    Article  CAS  PubMed  Google Scholar 

  77. Buchanan, T. A., Schemmer, J. K. & Freinkel, N. Embryotoxic effects of brief maternal insulin-hypoglycemia during organogenesis in the rat. J. Clin. Invest. 78, 643–649 (1986).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  78. Kawaguchi, M., Tanigawa, K., Tanaka, O. & Kato, Y. Embryonic growth impaired by maternal hypoglycemia during early organogenesis in normal and diabetic rats. Acta Diabetol. 31, 141–146 (1994).

    Article  CAS  PubMed  Google Scholar 

  79. Smoak, I. W. & Sadler, T. W. Embryopathic effects of short-term exposure to hypoglycemia in mouse embryos in vitro. Am. J. Obstet. Gynecol. 163, 619–624 (1990).

    Article  CAS  PubMed  Google Scholar 

  80. [No authors listed] Pregnancy outcomes in the Diabetes Control and Complications Trial. Am. J. Obstet. Gynecol. 174, 1343–1353 (1996).

  81. Ringholm, L., Pedersen-Bjergaard, U., Thorsteinsson, B., Damm, P. & Mathiesen, E. R. Hypoglycaemia during pregnancy in women with Type 1 diabetes. Diabet. Med. 29, 558–566 (2012).

    Article  CAS  PubMed  Google Scholar 

  82. Garcia-Dominguez, M. et al. Use of insulin lispro during pregnancy in women with pregestational diabetes mellitus. Med. Clin. (Barc.) 137, 581–586 (2011).

    Article  Google Scholar 

  83. Heller, S. R. et al. Hypoglycaemia with insulin aspart: a double-blind, randomised, crossover trial in subjects with Type 1 diabetes. Diabet. Med. 21, 769–775 (2004).

    Article  CAS  PubMed  Google Scholar 

  84. Imbergamo, M. P. et al. Use of glargine in pregnant women with type 1 diabetes mellitus: a case–control study. Clin. Ther. 30, 1476–1484 (2008).

    Article  CAS  PubMed  Google Scholar 

  85. Secher, A. L. et al. Patient satisfaction and barriers to initiating real-time continuous glucose monitoring in early pregnancy in women with diabetes. Diabet. Med. 29, 272–277 (2012).

    Article  CAS  PubMed  Google Scholar 

  86. Hegaard, H. K., Pedersen, B. K., Nielsen, B. B. & Damm, P. Leisure time physical activity during pregnancy and impact on gestational diabetes mellitus, pre-eclampsia, preterm delivery and birth weight: a review. Acta Obstet. Gynecol. Scand. 86, 1290–1296 (2007).

    Article  PubMed  Google Scholar 

  87. Jovanovic, L. G. Using meal-based self-monitoring of blood glucose as a tool to improve outcomes in pregnancy complicated by diabetes. Endocr. Pract. 14, 239–247 (2008).

    Article  PubMed  Google Scholar 

  88. Leontos, C. Implementing the American Diabetes Association's nutrition recommendations. J. Am. Osteopath. Assoc. 103, S17–S20 (2003).

    PubMed  Google Scholar 

  89. Hanson, U. & Persson, B. Epidemiology of pregnancy-induced hypertension and preeclampsia in type 1 (insulin-dependent) diabetic pregnancies in Sweden. Acta Obstet. Gynecol. Scand. 77, 620–624 (1998).

    Article  CAS  PubMed  Google Scholar 

  90. Holmes, V. A. et al. Optimal glycemic control, pre-eclampsia, and gestational hypertension in women with type 1 diabetes in the diabetes and pre-eclampsia intervention trial. Diabetes Care 34, 1683–1688 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  91. Siddiqi, T., Rosenn, B., Mimouni, F., Khoury, J. & Miodovnik, M. Hypertension during pregnancy in insulin-dependent diabetic women. Obstet. Gynecol. 77, 514–519 (1991).

    CAS  PubMed  Google Scholar 

  92. Bartha, J. L., Romero-Carmona, R., Torrejon-Cardoso, R., Comino-Delgado, R. Insulin, insulin-like growth factor-1, and insulin resistance in women with pregnancy-induced hypertension. Am. J. Obstet. Gynecol. 187, 735–740 (2002).

    Article  CAS  PubMed  Google Scholar 

  93. Seely, E. W. & Solomon, C. G. Insulin resistance and its potential role in pregnancy-induced hypertension. J. Clin. Endocrinol. Metab. 88, 2393–2398 (2003).

    Article  CAS  PubMed  Google Scholar 

  94. Sierra-Laguado, J. et al. Determination of insulin resistance using the homeostatic model assessment (HOMA) and its relation with the risk of developing pregnancy-induced hypertension. Am. J. Hypertens. 20, 437–442 (2007).

    Article  CAS  PubMed  Google Scholar 

  95. Solomon, C. G. & Seely, E. W. Brief review: hypertension in pregnancy: a manifestation of the insulin resistance syndrome? Hypertension 37, 232–239 (2001).

    Article  CAS  PubMed  Google Scholar 

  96. Ferriss, J. B. The causes of raised blood pressure in insulin-dependent and non-insulin-dependent diabetes. J. Hum. Hypertens. 5, 245–254 (1991).

    CAS  PubMed  Google Scholar 

  97. Leguizamon, G. F., Zeff, N. P. Fernandez A: Hypertension and the pregnancy complicated by diabetes. Curr. Diab. Rep. 6, 297–304 (2006).

    Article  CAS  PubMed  Google Scholar 

  98. Ekbom, P. et al. Pregnancy outcome in type 1 diabetic women with microalbuminuria. Diabetes Care 24, 1739–1744 (2001).

    Article  CAS  PubMed  Google Scholar 

  99. Rossing, K. et al. Pregnancy and progression of diabetic nephropathy. Diabetologia 45, 36–41 (2002).

    Article  CAS  PubMed  Google Scholar 

  100. Sibai, B. M. Diabetic nephropathy in pregnancy. in A Practical Manual of Diabetes in Pregnancy. 153–156 (Blackwell Publishing, Oxford, 2008).

    Google Scholar 

  101. [No authors listed] Blood glucose control and the evolution of diabetic retinopathy and albuminuria. A preliminary multicenter trial. The Kroc Collaborative Study Group. N. Engl. J. Med. 311, 365–372 (1984).

  102. [No authors listed] The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N. Engl. J. Med. 329, 977–986 (1993).

  103. Lawson, P. M. et al. Continuous subcutaneous insulin infusion (CSII) does not prevent progression of proliferative and preproliferative retinopathy. Br. J. Ophthalmol. 66, 762–766 (1982).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  104. Chew, E. Y. et al. Metabolic control and progression of retinopathy. The Diabetes in Early Pregnancy Study. National Institute of Child Health and Human Development Diabetes in Early Pregnancy Study. Diabetes Care 18, 631–637 (1995).

    Article  CAS  PubMed  Google Scholar 

  105. Okosieme, O. E., Marx, H. & Lazarus, J. H. Medical management of thyroid dysfunction in pregnancy and the postpartum. Expert Opin. Pharmacother. 9, 2281–2293 (2008).

    Article  CAS  PubMed  Google Scholar 

  106. Mathiesen, E. R., Ringholm, L. & Damm, P. Stillbirth in diabetic pregnancies. Best Pract. Res. Clin. Obstet. Gynaecol. 25, 105–111 (2011).

    Article  PubMed  Google Scholar 

  107. Conway, D. L. & Catalano, P. M. Obstetrical management of women with preexisting diabetes mellitus. In Managing Preexisting Diabetes and Pregnancy. American Diabetes Association Technical Reviews and Consensus Recommendations for Care. (Ed. Kitzmiller, J. L.) 561–601 (American Diabetes Association, 2008).

    Google Scholar 

  108. Jovanovic, L. Glucose and insulin requirements during labor and delivery: the case for normoglycemia in pregnancies complicated by diabetes. Endocr. Pract. 10, (Suppl. 2) 40–45 (2004).

    Article  PubMed  Google Scholar 

  109. Stage, E., Mathiesen, E. R., Emmersen, P. B., Greisen, G. & Damm, P. Diabetic mothers and their newborn infants—rooming-in and neonatal morbidity. Acta Paediatr. 99, 997–999 (2010).

    Article  CAS  PubMed  Google Scholar 

  110. Inturris, M. Benefits and concerns of breast-feeding in women with diabetes. In Managing Preexisting Diabetes and Pregnancy. (Ed. Kitzmiller, J. L.) 697–727 (American Diabetes Association, 2008).

    Google Scholar 

  111. Stage, E., Norgard, H., Damm, P. & Mathiesen, E. Long-term breast-feeding in women with type 1 diabetes. Diabetes Care 29, 771–774 (2006).

    Article  PubMed  Google Scholar 

  112. [No authors listed] Preparing pregnant women with diabetes for special breast-feeding challenges. J. Am. Diet. Assoc. 98, 648 (1998).

  113. Hummel, S. et al. Breastfeeding habits in families with Type 1 diabetes. Diabet. Med. 24, 671–676 (2007).

    Article  CAS  PubMed  Google Scholar 

  114. Sorkio, S. et al. Breastfeeding patterns of mothers with type 1 diabetes: results from an infant feeding trial. Diabetes Metab. Res. Rev. 26, 206–211 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  115. Riviello, C., Mello, G. & Jovanovic, L. G. Breastfeeding and the basal insulin requirement in type 1 diabetic women. Endocr. Pract. 15, 187–193 (2009).

    Article  PubMed  Google Scholar 

  116. Beardmore, K. S., Morris, J. M. & Gallery, E. D. Excretion of antihypertensive medication into human breast milk: a systematic review. Hypertens. Pregnancy 21, 85–95 (2002).

    Article  CAS  PubMed  Google Scholar 

  117. Shannon, M. E., Malecha, S. E. & Cha, A. J. Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) and lactation: an update. J. Hum. Lact. 16, 152–155 (2000).

    Article  CAS  PubMed  Google Scholar 

  118. Shannon, M. E., Malecha, S. E. & Cha, A. J. Beta blockers and lactation: an update. J. Hum. Lact. 16, 240–245 (2000).

    Article  CAS  PubMed  Google Scholar 

  119. [No authors listed] American Academy of Pediatrics Committee on Drugs: The transfer of drugs and other chemicals into human milk. Pediatrics 93, 137–150 (1994).

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Authors and Affiliations

  1. Center for Pregnant Women with Diabetes, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen Ø, DK 2100, Denmark

    Lene Ringholm, Elisabeth R. Mathiesen, Louise Kelstrup & Peter Damm

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  1. Lene Ringholm
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Contributions

L. Ringholm contributed to researching and discussing content, writing the manuscript and editing the article before submission. E. R. Mathiesen, L. Kelstrup and P. Damm contributed substantially to discussions of the content and reviewing and/or editing of the manuscript before submission.

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Correspondence to Lene Ringholm.

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Competing interests

P. Damm and E. R Mathiesen have acted as consultants for and received grant support from Novo Nordisk. E. R. Mathiesen has also received honoraria from Novo Nordisk. L. Ringholm and L. Kelstrup declare no competing interests.

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Ringholm, L., Mathiesen, E., Kelstrup, L. et al. Managing type 1 diabetes mellitus in pregnancy—from planning to breastfeeding. Nat Rev Endocrinol 8, 659–667 (2012). https://doi.org/10.1038/nrendo.2012.154

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