Begeleiding rondom de zwangerschap van vrouwen met diabetes mellitus type 2

- As a consequence of the increased prevalence of type 2 diabetes mellitus in younger age groups, the combination of this form of diabetes and pregnancy is seen more often. Three cases are described. A 31-year-old Caucasian woman with preconceptional type 2 diabetes mellitus presented at gestational week 8. She was receiving chronic treatment with oral hypoglycaemic drugs, and methyldopa due to the pregnancy. She was switched immediately to intensive insulin therapy, which resulted in reasonable glycaemic control. Delivery occurred prematurely at week 30 due to pre-eclampsia; the neonate died due to sepsis after 1 week. A 32-year-old Moroccan woman with previous gestational diabetes mellitus presented with hyperglycaemia during the first trimester, which suggested possible preconceptional type 2 diabetes mellitus. Insulin treatment was initiated, and the pregnancy continued without further consequence. A 34-year-old Moroccan woman with preconceptional type 2 diabetes mellitus was switched to intensive insulin treatment; conception was delayed until adequate glycaemic control was achieved. The pregnancy continued without further consequence. Insulin therapy should be initiated before conception in women with preconceptional type 2 diabetes mellitus that requires glucose-lowering therapy. Counselling and care are similar to that for women with type 1 diabetes mellitus. Women with a history of gestational diabetes should be counselled and tested before conception to detect silent type 2 diabetes mellitus. Given the high-risk nature of type 2 diabetes mellitus and pregnancy, specialist team care is mandatory.

Ned Tijdschr Geneeskd. 2008;152:121-4