Diabetes Mellitus (DM) comprises a group of metabolic disorders which are characterized by high concentrations of plasma glucose as a result of insufficient insulin secretion, totally or partially, and / or by a resistance to the action of it. Chronic hyperglycemia is associated with long-term damage to various organs, especially kidneys, eyes, nerves, heart and blood vessels.DM is considered the most common metabolic entity during pregnancy, occurring in about 5% of pregnancies. 90% of these patients have Gestational Diabetes Mellitus (GDM), or women with a genetic predisposition to diabetes or metabolic unable to adequately compensate diabetogenic effects of pregnancy, while the remaining 10% are women already diagnosed with diabetes before pregnancy (DM1, DM2 and other types) (1).
Modern resources in the management of diabetes (self-glucose monitoring at home, insulin pumps continuous subcutaneous application, multiple types of insulin, ultrasound and fetal biophysical monitoring), have revolutionized the outcome of pregnancies complicated with this relatively common disorder. Before the discovery of insulin by Banting and Best in 1922, the culmination of pregnancy was probably the death of both mother and fetus, with the use of this hormone decreased dramatically the risks to pregnant women and their product.
In 1939, Priscilla White et al (2) report the successful management of 245 diabetic pregnant and found that the incidence of maternal diabetic ketoacidosis had declined dramatically and that frequency of stillbirths was half of that reported in the period preinsulina.The next three decades showed that pregnancy outcome was closely related to the metabolic control during this period, perinatal mortality rates fell from 35 to 10%.In 1970 he introduced the interdisciplinary management of diabetic pregnant, this and the new technologies as monitoring fetal biophysical assessment of fetal growth by ultrasound and analysis of fetal lung maturity in amniotic fluid (LA), markedly reduce morbidity neonatal. However, there are still major problems in the management of the mother and fetus. Although stillbirth rates have declined significantly, they question how costly biophysical testing and high rates of preterm births and caesarean section. Congenital anomalies are still 7-15 times more common in pregnant women with diabetes than pregnant women without the disease and macrosomia and birth trauma occur with a frequency 10 times higher in diabetic fetuses. (1, 3).
Our knowledge of the interrelationship of diet, physical activity, stress, glucose levels and fetal well-being, remains rudimentary and are unable to prevent macrosomia and birth trauma without unacceptably high rates of caesarean section (3)