The Diabetologist #10

diabetes. Unplanned pregnancies therefore remain a
major problem. Further research into possible ways
of improving the efficacy of prepregnancy programs
are warranted. Such studies should take into account
socio-economic, cultural and ethnic factors, that can
strongly influence a woman’s acceptance, understanding
and adherence to restrictions imposed by a diabetic
pregnancy.26
Education is a prerequisite for adequate diabetes
self-management, but by no means a guarantee that
patients will indeed adhere to the diabetes regimen.
In order to help women to cope more effectively with
their diabetes, it is essential to identify their specific
psychological and behavioral barriers, such as low diabetes
identify their specific psychological and behavioral
barriers, such as low diabetes self-efficacy, fear of
hypoglycemia and lack of social support. Customized
psychosocial interventions should prove helpful in improving
the outcome of diabetic pregnancies as well as
the women’s quality of life.
New technologies in monitoring glycemic control
should be evaluated regarding their psychological implications.
Continuous glucose monitoring (CGM) is a
promising technique that appears useful in detecting
high postprandial blood glucose levels and nocturnal
hypoglycaemic events that are unrecognized by intermittent
blood glucose measurements.27The psychological
consequences of CGM in pregnant diabetic
women who are confronted with concealed high and
low levels of blood glucose despite tight monitoring
should be a subject of future studies.
The importance of a follow-up protocol after delivery
is emphasized by the observation that glycemic control
often quickly deteriorates after delivery, returning to
suboptimal prepregnancy levels.
In the last decades, much progress has been made
in the medical management of diabetic pregnancy. A
large number of health care professionals is involved
in medical care for pregnant women with diabetes.
Dedicated medical specialists (obstetricians, endocrinologists,
ophthalmologists, nephrologists, neonatologists),
diabetic nurses and dietary consultants have
their specific shares in the prevention, diagnosis and
treatment of maternal and perinatal complications. In
daily practice, it appears difficult to attune the activities
of these different professionals to each other. In
Amsterdam (VU medical center), an integrated pregnancy
and diabetes clinic was started in April 2004 to
overcome these problems and improve the care for the
pregnant woman with diabetes and her child (to-be).
The rates of complications and women’s satisfaction
with the provided care will be evaluated and used to
further improve the quality of care.
Next to the medical aspects of diabetic pregnancy,
psychological and social issues appear to be important
determinants of pregnancy outcome and possibly
provide a key to further enhancement of diabetes
care in pregnancy. The integration of psychological
expertise with specialized medical care may provide
a substantial contribution to a further improvement
of multidisciplinary diabetes management in pregnancy.
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issue 10 < APRIL 2012