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Contraception, pregnancy and breast feeding in the insulin-dependent diabetic.


 Improved glycemic control of diabetic women from before conception until after delivery has resulted in a reduction of the perinatal mortality rate of infants of diabetic mothers to below 5%. Nonetheless, 3 major issues remain problematic: 1) pregnancy in diabetic patients with severe complications of the disease, e.g., renal disease, hypertension, and ischemic heart disease; 2) the management of patients whose cooperation and compliance are poor in terms of following medical advice; and 3) the high incidence (4-10%) of severe and often multiple congenital malformations. Reliable contraception is thus particularly important for diabetic women. The progestogen-only pill is an especially good contraceptive choice for diabetic women since it does not upset blood glucose control or carry any increased risk of vascular disease. When the family is complete or the woman's life would be threatened by pregnancy, sterilization may be the preferred alternative. Prospective mothers with diabetes should be encouraged to attend a specialized prepregnancy clinic several months before conception is attempted for an assessment of readiness for pregnancy. The care of the pregnant women with diabetes is also best provided at a specialized clinic in view of the need for strict blood glucose control. An increasing proportion of women with diabetes are being delivered at term and vaginally, although the cesarean section rate remains well above that of the general population. Finally, diabetic mothers are as likely to be able to breast feed as their non-diabetic counterparts.
