Experts urge treatment for diabetic pregnant women

Getting the blood sugar of a pregnant woman with diabetes as close to normal as possible is the key to making it more likely that her baby will be born healthy, according to a presentation on the subject at the American Assn. of Clinical Endocrinologists Annual Meeting and Clinical Congress last month in Chicago. Experts warn, though, that rapid normalization, particularly for women whose control has not been stable before the pregnancy, can trigger an equally rapid progression of retinopathy.

"The ophthalmologist has to be with me and keep up with me if the eye starts to change because there are risks if you go too quickly," said Lois G. Jovanovic, MD, who led the presentation and is the CEO and chief scientific officer of the Sansum Diabetes Research Institute in Santa Barbara, Calif. "But if we can normalize the blood sugar, we can normalize the outcome of the pregnancy."

Dr. Jovanovic said most of the women she works with are willing to take the risk to increase the chance that they will deliver a healthy baby, but such tight diabetes control during pregnancy is controversial. This circumstance, however, is expected to be resolved in 2007 with the release of data from the Hyperglycemia and Adverse Pregnancy Outcome trial.

This multinational study of 25,000 pregnant women funded by the National Institutes of Health and the American Diabetes Assn. is expected to answer definitively the question of the best management strategy for this population. Still, for the moment, experts are advocating tight control as the answer.

"What do we do while we wait?" Dr. Jovanovic asked. "We have to normalize the blood glucose."

Experts also are calling for increasing recognition that many cases of gestational diabetes actually might be the disease's type 2 version that was undiagnosed before the pregnancy. The fact that gestational diabetes increases the risk of eventually developing type 2 diabetes long has been recognized, but experts now are saying that many women might have it already and that diabetes care usually will have to continue without interruption after delivery.

"Many are really undiagnosed type 2's," Dr. Jovanovic said. "Hyperglycemia doesn't happen overnight. Acanthosis nigricans doesn't happen overnight."