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Diabetes and pregnancy.

Metabolic and hormonal changes in diabetic pregnancies and their cli nical implications are discussed. During pregnancy fasting blood glucose levels decline while free fatty acid concentrations increase. These alterations depend upon food deprivation gestational age and metabolic alterations such as diabetes mellitus. In the third trimester of pregnancy fasting serum proinsulin levels are increased. Quantitati ve differences in the response to oral and intravenous glucose (OGT and IGT) are discussed. The insulinotropic and contrainsulin properties of human placental lactogen may be responsible for the increase in levels of free fatty acids during pregnancy. Plasma and urinary levels of estrogens progressively increase over the course of pregnancy though levels of estrone and estradiol have been found to be lower in diabetic pregnancies. It is possible that progesterone inhibits the diabetogenic effect of hydrocortisone though it is unlikely that it plays a more significant role in diabetic pregnancies than normal pregnancies. Levels of corticosteroids are also increased during pregnancy especially in the third trimester. Considerations in the management of diabetes mellitus of pregnancy are discussed.