By Gerard N. Burrow, M.D., Thomas P. Duffy, M.D., and Joshua A. Copel, M.D. (Eds.)
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Additional resources for Medical Complications During Pregnancy
Among cases of infarction during pregnancy or in the puerperium, seven mothers and seven infants died, whereas in the seven cases in which the myocardial event occurred before pregnancy, all of the mothers and infants survived. The better outcomes reported since 1980 may reflect improved care or reporting bias of unexpectedly successful outcomes despite preexisting coronary artery disease. The increased cardiac output during pregnancy and, in particular, the immediate 60% to 80% increase in cardiac output that occurs in the immediate postpartum period leaves the woman at risk for pulmonary edema and further myocardial damage.
Previous glycemic control. The actual mechanisms by which glycemia adversely affects the retinal vasculature are not well understood but are probably multifactorial. An increasingly important role is being ascribed to various local growth factors, such as vascular endothelial growth factor and IGF-1. Of note, maternal concentrations of both of these factors increase during pregnancy, which may in part provide a pathophysiologic basis for the worsening of diabetic retinopathy that is often encountered during pregnancy.
In one uncontrolled observational study of 132 pregnancies in 91 women with type 1 diabetes, the spontaneous abortion rate was 30%, the incidence peaking between the 10th and 12th gestational weeks. This is more than twice the frequency reported in the literature from normal pregnancies. This group of patients was, however, generally treated suboptimally by modern standards during the preconception phase. Higher abortion rates were associated with more advanced White classification, but relationship with glycemic control was not assessed.
Medical Complications During Pregnancy by Gerard N. Burrow, M.D., Thomas P. Duffy, M.D., and Joshua A. Copel, M.D. (Eds.)