Anesthesia for the Pregnant Diabetic Patient

  • Emine Aysu Salviz


Diabetes mellitus (DM) is a group of metabolic disorders characterized by hyperglycemia. Especially Type 2 DM has a steadily increasing prevalence because of obesity, and this has led the anesthesiologists to meet more women at childbearing age diagnosed with DM. Additionally, parturients, who are unable to produce enough insulin to compensate insulin resistance in the second or third trimester of pregnancy, are diagnosed with gestational DM. The leading risk factors are advanced maternal age, obesity, family history of Type 2 DM, and previous diagnosis of gestational DM.

Diabetes mellitus can be associated with acute and chronic complications affecting both the mother and the fetus during pregnancy. Therefore, optimal glycemic control, appropriate obstetric management of existing and probable complications (hypoglycemia, diabetic ketoacidosis, nonketotic hyperosmolar state, microvascular and macrovascular complications, etc.), detailed preanesthetic evaluation (autonomic neuropathy, stiff joint, etc.), appropriate analgesic, and anesthetic management are of utmost importance in parturients with DM.

Epidural analgesia is the most commonly used technique for vaginal delivery to provide excellent labor pain management. In terms of anesthesia, epidural technique is again of choice when a parturient with DM has a chronic uteroplacental insufficiency. If urgent Cesarean delivery is required, spinal anesthesia is usually preferred over general anesthesia because of its safety profile. In the anesthetic management of parturients with DM, particular attention should be paid to the increased risk of hypotension and aspiration.


Diabetes mellitus Gestational diabetes mellitus Parturient Anesthesia Analgesia 


  1. 1.
    American Diabetes Association. Standards of medical care in diabetes-2017. Diabetes Care. 2017;40(Suppl1):S1–135.Google Scholar
  2. 2.
    Ioannou GN, Bryson CL, Boyko EJ. Prevalence and trends of insulin resistance, impaired fasting glucose, and diabetes. J Diabetes Complicat. 2007;21(6):363–70.PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Bays HE, Bazata DD, Clark NG, Gavin JR 3rd, Green AJ, Lewis SJ, et al. Prevalence of self-reported diagnosis of diabetes mellitus and associated risk factors in a national survey in the US population: SHIELD (study to help improve early evaluation and management of risk factors leading to diabetes). BMC Public Health. 2007;7:277.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Fragneto RY. The high-risk obstetric patient. In: Braveman F, editor. Obstetric and gynecologic anesthesia. The requisites in anesthesiology. 1st ed. Philadelphia: Elsevier; 2006. p. 79–113.CrossRefGoogle Scholar
  5. 5.
    ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 30. Obstet Gynecol. 2001;98(3):525–38.CrossRefGoogle Scholar
  6. 6.
    Lawrence JM, Contreras R, Chen W, Sacks DA. Trends in the prevalence of preexisting diabetes and gestational diabetes mellitus among a racially/ethnically diverse population of pregnant women, 1999–2005. Diabetes Care. 2008;31(5):899–904.PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 1997;20(7):1183–97.CrossRefGoogle Scholar
  8. 8.
    White P. Pregnancy complicating diabetes. Am J Med. 1949;7(5):609–16.PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    White P. Classification of obstetric diabetes. Am J Obstet Gynecol. 1978;130(2):228–30.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Kapoor N, Sankaran S, Hyer S, Shehata H. Diabetes in pregnancy: a review of current evidence. Curr Opin Obstet Gynecol. 2007;19(6):586–90.PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    McCance DR. Diabetes in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2015;29(5):685–99.PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Wissler RN. Endocrine disorders. In: Chestnut DH, Polley LS, Tsen LC, Wong CA, editors. Chestnut’s obstetric anesthesia. Principles and practice. 4th ed. Philadelphia: Elsevier; 2009. p. 913–41.CrossRefGoogle Scholar
  13. 13.
    Kitabchi AE, Nyenwe EA. Hyperglycemic crises in diabetes mellitus: diabetic ketoacidosis and hyperglycemic hyperosmolar state. Endocrinol Metab Clin North Am. 2006;35(4):725–51, viii.PubMedCrossRefPubMedCentralGoogle Scholar
  14. 14.
    Montoro MN, Myers VP, Mestman JH, Xu Y, Anderson BG, Golde SH. Outcome of pregnancy in diabetic ketoacidosis. Am J Perinatol. 1993;10(1):17–20.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Robertson G, Wheatley T, Robinson RE. Ketoacidosis in pregnancy: an unusual presentation of diabetes mellitus: case reports. Br J Obstet Gynaecol. 1986;93(10):1088–90.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Cousins L. Pregnancy complications among diabetic women: review 1965-1985. Obstet Gynecol Surv. 1987;42(3):140–9.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Parker JA, Conway DL. Diabetic ketoacidosis in pregnancy. Obstet Gynecol Clin North Am. 2007;34(3):533–43, xii.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Wallace TM, Matthews DR. Recent advances in the monitoring and management of diabetic ketoacidosis. QJM. 2004;97(12):773–80.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    ter Braak EW, Evers IM, Willem Erkelens D, Visser GH. Maternal hypoglycemia during pregnancy in type I diabetes: maternal and fetal consequences. Diabetes Metab Res Rev. 2002;18(2):96–105.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Kimmerle R, Heinemann L, Delecki A, Berger M. Severe hypoglycemia incidence and predisposing factors in 85 pregnancies of type I diabetic women. Diabetes Care. 1992;15(8):1034–7.PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Rosenn BM, Miodovnik M, Holcberg G, Khoury JC, Siddiqi TA. Hypoglycemia: the price of intensive insulin therapy for pregnant women with insulin-dependent diabetes mellitus. Obstet Gynecol. 1995;85(3):417–22.PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    Lankford HV, Bartholomew SP. Severe hypoglycemia in diabetic pregnancy. Va Med Q. 1992;119(3):172–4.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Nielsen LR, Pedersen-Bjergaard U, Thorsteinsson B, Johansen M, Damm P, Mathiesen ER. Hypoglycemia in pregnant women with type 1 diabetes: predictors and role of metabolic control. Diabetes Care. 2008;31(1):9–14.PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    International Hypoglycaemia Study Group. Glucose concentrations of less than 3.0 mmol/L (54 mg/dL) should be reported in clinical trials: a joint position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2017;40(1):155–7.CrossRefGoogle Scholar
  25. 25.
    Seaquist ER, Anderson J, Childs B, Cryer P, Dagogo-Jack S, Fish L, et al. Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society. Diabetes Care. 2013;36(5):1384–95.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Tuomilehto J. The emerging global epidemic of type 1 diabetes. Curr Diab Rep. 2013;13(6):795–804.PubMedCrossRefPubMedCentralGoogle Scholar
  27. 27.
    Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Diabetes Prevention Program Research Group, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403.CrossRefGoogle Scholar
  28. 28.
    King P, Peacock I, Donnelly R. The UK prospective diabetes study (UKPDS): clinical and therapeutic implications for type 2 diabetes. Br J Clin Pharmacol. 1999;48(5):643–8.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    American Diabetes Association. Standards of medical care in diabetes-2008. Diabetes Care. 2008;31(Suppl 1):S12–54.CrossRefGoogle Scholar
  30. 30.
    Santiago JV. Overview of the complications of diabetes. Clin Chem. 1986;32(10 Suppl):B48–53.PubMedGoogle Scholar
  31. 31.
    Pastors JG, Warshaw H, Daly A, Franz M, Kulkarni K. The evidence for the effectiveness of medical nutrition therapy in diabetes management. Diabetes Care. 2002;25(3):608–13.PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Lim EL, Hollingsworth KG, Aribisala BS, Chen MJ, Mathers JC, Taylor R. Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia. 2011;54(10):2506–14.PubMedPubMedCentralCrossRefGoogle Scholar
  33. 33.
    Jackness C, Karmally W, Febres G, Conwell IM, Ahmed L, Bessler M, et al. Very low-calorie diet mimics the early beneficial effect of Roux-en-Y gastric bypass on insulin sensitivity and b-cell function in type 2 diabetic patients. Diabetes. 2013;62(9):3027–32.PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    Rothberg AE, McEwen LN, Kraftson AT, Fowler CE, Herman WH. Very-low-energy diet for type 2 diabetes: an underutilized therapy? J Diabetes Complicat. 2014;28(4):506–10.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Diabetes Control and Complications Trial Research Group, Nathan DM, Genuth S, Lachin J, Cleary P, Crofford O, et al. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977–86.CrossRefGoogle Scholar
  36. 36.
    Amour J, Kersten JR. Diabetic cardiomyopathy and anesthesia: bench to bedside. Anesthesiology. 2008;108(3):524–30.PubMedCrossRefGoogle Scholar
  37. 37.
    Peterson CM, Jovanovic-Peterson L, Mills JL, Conley MR, Knopp RH, Reed GF, et al. The diabetes in early pregnancy study: changes in cholesterol, triglycerides, body weight, and blood pressure. Am J Obstet Gynecol. 1992;166(2):513–8.PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    Siddiqi T, Rosenn B, Mimouni F, Khoury J, Miodovnik M. Hypertension during pregnancy in insulin-dependent diabetic women. Obstet Gynecol. 1991;77(4):514–9.PubMedGoogle Scholar
  39. 39.
    Sibai BM, Caritis S, Hauth J, Lindheimer M, Van Dorsten JP, Mac Pherson C, et al. Risks of preeclampsia and adverse neonatal outcomes among women with pregestational diabetes mellitus. Am J Obstet Gynecol. 2000;182(2):364–9.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358(19):1991–2002.CrossRefGoogle Scholar
  41. 41.
    O’Kane MJ, Lynch PL, Moles KW, Magee SE. Determination of a diabetes control and complications trial-aligned HbA(1c) reference range in pregnancy. Clin Chim Acta. 2001;311(2):157–9.PubMedCrossRefGoogle Scholar
  42. 42.
    International Association of Diabetes and Pregnancy Study Groups Consensus Panel, Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, et al. International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33(3):676–82.PubMedCentralCrossRefPubMedGoogle Scholar
  43. 43.
    American Diabetes Association. Standards of medical care in diabetes 2011. Diabetes Care. 2011;34(Suppl. 1):S11–61.PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.
    Vandorsten JP, Dodson WC, Espeland MA, Grobman WA, Guise JM, Mercer BM, et al. NIH consensus development conference: diagnosing gestational diabetes mellitus. NIH Consens State Sci Statements. 2013;29(1):1–31.PubMedGoogle Scholar
  45. 45.
    Wei Y, Yang H, Zhu W, Yang H, Li H, Yan J, et al. International Association of Diabetes and Pregnancy Study Group criteria is suitable for gestational diabetes mellitus diagnosis: further evidence from China. Chin Med J. 2014;127(20):3553–6.PubMedGoogle Scholar
  46. 46.
    Feldman RK, Tieu RS, Yasumura L. Gestational diabetes screening: the International Association of the Diabetes and Pregnancy Study Groups compared with Carpenter-Coustan screening. Obstet Gynecol. 2016;127(1):10–7.PubMedCrossRefGoogle Scholar
  47. 47.
    Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 137: gestational diabetes mellitus. Obstet Gynecol. 2013;122:406–46.CrossRefGoogle Scholar
  48. 48.
    Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol. 1982;144(7):768–73.PubMedCrossRefGoogle Scholar
  49. 49.
    National Diabetes Data Group. Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes. 1979;28(12):1039–57.CrossRefGoogle Scholar
  50. 50.
    Ethridge JK Jr, Catalano PM, Waters TP. Perinatal outcomes associated with the diagnosis of gestational diabetes made by the International Association of the Diabetes and Pregnancy Study Groups criteria. Obstet Gynecol. 2014;124(3):571–8.PubMedPubMedCentralCrossRefGoogle Scholar
  51. 51.
    Mayo K, Melamed N, Vandenberghe H, Berger H. The impact of adoption of the International Association of Diabetes in Pregnancy Study Group criteria for the screening and diagnosis of gestational diabetes. Am J Obstet Gynecol. 2015;212(2):224.e1–9.CrossRefGoogle Scholar
  52. 52.
    Duran A, Saenz S, Torrejon MJ, Bordiu E, Del Valle L, Galindo M, et al. Introduction of IADPSG criteria for the screening and diagnosis of gestational diabetes mellitus results in improved pregnancy outcomes at a lower cost in a large cohort of pregnant women: the St. Carlos Gestational Diabetes Study. Diabetes Care. 2014;37(9):2442–50.PubMedCrossRefGoogle Scholar
  53. 53.
    Sorenson RL, Brelje TC. Adaptation of islets of Langerhans to pregnancy: Beta-cell growth, enhanced insulin secretion and the role of lactogenic hormones. Horm Metab Res. 1997;29(6):301–7.PubMedCrossRefGoogle Scholar
  54. 54.
    Picard F, Wanatabe M, Schoonjans K, Lydon J, O’Malley BW, Auwerx J. Progesterone receptor knockout mice have an improved glucose homeostasis secondary to beta-cell proliferation. Proc Natl Acad Sci U S A. 2002;99(24):15644–8.PubMedPubMedCentralCrossRefGoogle Scholar
  55. 55.
    Jovanovic-Peterson L, Peterson CM. Pregnancy in the diabetic woman: guidelines for a successful outcome. Endocrinol Metab Clin N Am. 1992;21(2):433–56.CrossRefGoogle Scholar
  56. 56.
    Hare JW. Insulin management of type I and type II diabetes in pregnancy. Clin Obstet Gynecol. 1991;34(3):494–504.PubMedCrossRefGoogle Scholar
  57. 57.
    Maheux PC, Bonin B, Dizazo A, Guimond P, Monier D, Bourque J, et al. Glucose homeostasis during spontaneous labor in normal human pregnancy. J Clin Endocrinol Metab. 1996;81(1):209–15.PubMedGoogle Scholar
  58. 58.
    Holst N, Jenssen TG, Burhol PG, Jorde R, Maltau JM. Plasma vasoactive intestinal peptide, insulin, gastric inhibitory polypeptide, and blood glucose in late pregnancy and during and after delivery. Am J Obstet Gynecol. 1986;155(1):126–31.PubMedCrossRefGoogle Scholar
  59. 59.
    Jovanovic L, Peterson CM. Insulin and glucose requirements during the first stage of labor in insulin-dependent diabetic women. Am J Med. 1983;75(4):607–12.PubMedCrossRefGoogle Scholar
  60. 60.
    Caplan RH, Pagliara AS, Beguin EA, Smiley CA, Bina-Frymark M, Goettl KA, et al. Constant intravenous insulin infusion during labor and delivery in diabetes mellitus. Diabetes Care. 1982;5(1):6–10.PubMedCrossRefGoogle Scholar
  61. 61.
    Crombach G, Siebolds M, Mies R. Insulin use in pregnancy: clinical pharmacokinetic considerations. Clin Pharmacokinet. 1993;24(2):89–100.PubMedCrossRefGoogle Scholar
  62. 62.
    Davies HA, Clark JD, Dalton KJ, Edwards OM. Insulin requirements of diabetic women who breast feed. BMJ. 1989;298(6684):1357–8.PubMedPubMedCentralCrossRefGoogle Scholar
  63. 63.
    Horvath K, Koch K, Jeitler K, Matyas E, Bender R, Bastian H, et al. Effects of treatment in women with gestational diabetes mellitus: systematic review and meta-analysis. BMJ. 2010;340:c1395.PubMedPubMedCentralCrossRefGoogle Scholar
  64. 64.
    Reece EA, Homko CJ. Prepregnancy care and the prevention of fetal malformations in the pregnancy complicated by diabetes. Clin Obstet Gynecol. 2007;50(4):990–7.PubMedCrossRefGoogle Scholar
  65. 65.
    Jacobson JD, Cousins L. A population-based study of maternal and perinatal outcome in patients with gestational diabetes. Am J Obstet Gynecol. 1989;161(4):981–6.PubMedCrossRefGoogle Scholar
  66. 66.
    Mimouni F, Miodovnik M, Whitsett JA, Holroyde JC, Siddiqi TA, Tsang RC. Respiratory distress syndrome in infants of diabetic mothers in the 1980s: no direct adverse effect of maternal diabetes with modern management. Obstet Gynecol. 1987;69(2):191–5.PubMedGoogle Scholar
  67. 67.
    Piper JM, Langer O. Does maternal diabetes delay fetal pulmonary maturity? Am J Obstet Gynecol. 1993;168(3 Pt 1):783–6.PubMedCrossRefGoogle Scholar
  68. 68.
    Bo S, Menato G, Gallo ML, Bardelli C, Lezo A, Signorile A, et al. Mild gestational hyperglycemia, the metabolic syndrome and adverse neonatal outcomes. Acta Obstet Gynecol Scand. 2004;83(4):335–40.PubMedCrossRefGoogle Scholar
  69. 69.
    Guerin A, Nisenbaum R, Ray JG. Use of maternal GHb concentration to estimate the risk of congenital anomalies in the offspring of women with prepregnancy diabetes. Diabetes Care. 2007;30(7):1920–5.PubMedCrossRefGoogle Scholar
  70. 70.
    Jensen DM, Korsholm L, Ovesen P, Beck-Nielsen H, Moelsted-Pedersen L, Westergaard JG, et al. Peri-conceptional A1C and risk of serious adverse pregnancy outcome in 933 women with type 1 diabetes. Diabetes Care. 2009;32(6):1046–8.PubMedPubMedCentralCrossRefGoogle Scholar
  71. 71.
    Charron-Prochownik D, Downs J. Diabetes and reproductive health for girls. Alexandria: American Diabetes Association; 2016.Google Scholar
  72. 72.
    Nielsen GL, Møller M, Sørensen HT. HbA1c in early diabetic pregnancy and pregnancy outcomes: a Danish population-based cohort study of 573 pregnancies in women with type 1 diabetes. Diabetes Care. 2006;29(12):2612–6.PubMedCrossRefPubMedCentralGoogle Scholar
  73. 73.
    Suhonen L, Hiilesmaa V, Teramo K. Glycaemic control during early pregnancy and fetal malformations in women with type 1 diabetes mellitus. Diabetologia. 2000;43(1):79–82.PubMedCrossRefPubMedCentralGoogle Scholar
  74. 74.
    Maresh MJ, Holmes VA, Patterson CC, Young IS, Pearson DW, Diabetes and Pre-eclampsia Intervention Trial Study Group, et al. Glycemic targets in the second and third trimester of pregnancy for women with type 1 diabetes. Diabetes Care. 2015;38(1):34–42.PubMedCrossRefPubMedCentralGoogle Scholar
  75. 75.
    Manderson JG, Patterson CC, Hadden DR, Traub AI, Ennis C, McCance DR. Preprandial versus postprandial blood glucose monitoring in type 1 diabetic pregnancy: a randomized controlled clinical trial. Am J Obstet Gynecol. 2003;189(2):507–12.PubMedCrossRefPubMedCentralGoogle Scholar
  76. 76.
    de Veciana M, Major CA, Morgan MA, Asrat T, Toohey JS, Lien JM, et al. Postprandial versus preprandial blood glucose monitoring in women with gestational diabetes mellitus requiring insulin therapy. N Engl J Med. 1995;333(19):1237–41.PubMedCrossRefPubMedCentralGoogle Scholar
  77. 77.
    Jovanovic-Peterson L, Peterson CM, Reed GF, Metzger BE, Mills JL, Knopp RH, et al. Maternal postprandial glucose levels and infant birth weight: the Diabetes in Early Pregnancy Study. The National Institute of Child Health and Human Development – Diabetes in Early Pregnancy Study. Am J Obstet Gynecol. 1991;164(1 Pt 1):103–11.PubMedCrossRefPubMedCentralGoogle Scholar
  78. 78.
    Hartling L, Dryden DM, Guthrie A, Muise M, Vandermeer B, Donovan L. Benefits and harms of treating gestational diabetes mellitus: a systematic review and meta-analysis for the U.S. Preventive Services Task Force and the National Institutes of Health Office of Medical Applications of Research. Ann Intern Med. 2013;159(2):123–9.PubMedCrossRefGoogle Scholar
  79. 79.
    Langer O. From educated guess to accepted practice: the use of oral antidiabetic agents in pregnancy. Clin Obstet Gynecol. 2007;50(4):959–71.PubMedCrossRefGoogle Scholar
  80. 80.
    Feig DS, Briggs GG, Koren G. Oral antidiabetic agents in pregnancy and lactation: a paradigm shift? Ann Pharmacother. 2007;41(7):1174–80.PubMedCrossRefPubMedCentralGoogle Scholar
  81. 81.
    Rowan JA, Hague WM, Gao W, Battin MR, Moore MP, MiG Trial Investigators. Metformin versus insulin for the treatment of gestational diabetes. N Engl J Med. 2008;358(19):2003–15.PubMedCrossRefGoogle Scholar
  82. 82.
    Gui J, Liu Q, Feng L. Metformin vs insulin in the management of gestational diabetes: a meta-analysis. PLoS One. 2013;8(5):e64585.PubMedPubMedCentralCrossRefGoogle Scholar
  83. 83.
    Langer O, Conway DL, Berkus MD, Xenakis EM, Gonzales O. A comparison of glyburide and insulin in women with gestational diabetes mellitus. N Engl J Med. 2000;343(16):1134–8.PubMedCrossRefPubMedCentralGoogle Scholar
  84. 84.
    Coustan DR. Pharmacological management of gestational diabetes: an overview. Diabetes Care. 2007;30(Suppl. 2):S206–8.PubMedCrossRefPubMedCentralGoogle Scholar
  85. 85.
    Landon MB, Gabbe SG, Sachs L. Management of diabetes mellitus and pregnancy: a survey of obstetricians and maternal-fetal specialists. Obstet Gynecol. 1990;75(4):635–40.PubMedPubMedCentralGoogle Scholar
  86. 86.
    American College of Obstetricians and Gynecologists. Pregestational diabetes mellitus. ACOG Practice Bulletin No. 60. Washington DC, March 2005. Obstet Gynecol. 2005;105:675–84.CrossRefGoogle Scholar
  87. 87.
    Burgos LG, Ebert TJ, Asiddao C, Turner LA, Pattison CZ, Wang-Cheng R, et al. Increased intraoperative cardiovascular morbidity in diabetics with autonomic neuropathy. Anesthesiology. 1989;70(4):591–7.PubMedCrossRefPubMedCentralGoogle Scholar
  88. 88.
    Pani N, Mishra SB, Rath SK. Diabetic parturient-anaesthetic implications. Indian J Anaesth. 2010;54(5):387–93.PubMedPubMedCentralCrossRefGoogle Scholar
  89. 89.
    Datta S, Brown WU Jr. Acid-base status in diabetic mothers and their infants following general or spinal anesthesia for cesarean section. Anesthesiology. 1977;47(3):272–6.PubMedCrossRefPubMedCentralGoogle Scholar
  90. 90.
    Datta S, Brown WU Jr, Ostheimer GW, Weiss JB, Alper MH. Epidural anesthesia for cesarean section in diabetic parturients: maternal and neonatal acid-base status and bupivacaine concentration. Anesth Analg. 1981;60(8):574–8.PubMedCrossRefPubMedCentralGoogle Scholar
  91. 91.
    Datta S, Kitzmiller JL, Naulty JS, Ostheimer GW, Weiss JB. Acid-base status of diabetic mothers and their infants following spinal anesthesia for cesarean section. Anesth Analg. 1982;61(8):662–5.PubMedCrossRefPubMedCentralGoogle Scholar
  92. 92.
    Ramanathan S, Khoo P, Arismendy J. Perioperative maternal and neonatal acid-base status and glucose metabolism in patients with insulin-dependent diabetes mellitus. Anesth Analg. 1991;73(2):105–11.PubMedCrossRefPubMedCentralGoogle Scholar
  93. 93.
    Eastwood DW. Anterior spinal artery syndrome after epidural anesthesia in a pregnant diabetic patient with scleredema. Anesth Analg. 1991;73(1):90–1.PubMedCrossRefPubMedCentralGoogle Scholar
  94. 94.
    Rodrigo N, Perera KN, Ranwala R, Jayasinghe S, Warnakulasuriya A, Hapuarachchi S. Aspergillus meningitis following spinal anaesthesia for caesarean section in Colombo, Sri Lanka. Int J Obstet Anesth. 2007;16(3):256–60.PubMedCrossRefPubMedCentralGoogle Scholar
  95. 95.
    Moen V, Dahlgren N, Irestedt L. Severe neurological complications after central neuraxial blockades in Sweden, 1990-1999. Anesthesiology. 2004;101(4):950–9.PubMedCrossRefPubMedCentralGoogle Scholar
  96. 96.
    Wang LP, Hauerberg J, Schmidt JF. Incidence of spinal epidural abscess after epidural analgesia: a national 1-year survey. Anesthesiology. 1999;91(6):1928–36.PubMedCrossRefPubMedCentralGoogle Scholar
  97. 97.
    Hebl JR, Kopp SL, Schroeder DR, Horlocker TT. Neurologic complications after neuraxial anesthesia or analgesia in patients with preexisting peripheral sensorimotor neuropathy or diabetic polyneuropathy. Anesth Analg. 2006;103(5):1294–9.PubMedCrossRefPubMedCentralGoogle Scholar
  98. 98.
    Vohra A, Kumar S, Charlton AJ, Olukoga AO, Boulton AJ, McLeod D. Effect of diabetes mellitus on the cardiovascular responses to induction of anesthesia and tracheal intubation. Br J Anaesth. 1993;71(2):258–61.PubMedCrossRefPubMedCentralGoogle Scholar
  99. 99.
    Lev-Ran A. Sharp temporary drop in insulin requirement after caesarean section in diabetic patients. Am J Obstet Gynecol. 1974;120(7):905–8.PubMedCrossRefPubMedCentralGoogle Scholar
  100. 100.
    Attallah MM, Daif AA, Saied MMA, Sonbul ZM. Neuromuscular blocking activity of tubocurarine in patients with diabetes mellitus. Br J Anaesth. 1992;68(6):567–9.CrossRefGoogle Scholar
  101. 101.
    Saitoh Y, Kaneda K, Hattori H, Nakajima H, Murakawa M. Monitoring of neuromuscular block after administration of vecuronium in patients with diabetes mellitus. Br J Anaesth. 2003;90(4):480–6.PubMedCrossRefPubMedCentralGoogle Scholar
  102. 102.
    Rosenbloom AL. Skeletal and joint manifestations of childhood diabetes. Pediatr Clin North Am. 1984;31(3):569–89.PubMedCrossRefPubMedCentralGoogle Scholar
  103. 103.
    Metzger BE. Long-term outcomes in mothers diagnosed with gestational diabetes mellitus and their offspring. Clin Obstet Gynecol. 2007;50(4):972–9.PubMedCrossRefPubMedCentralGoogle Scholar
  104. 104.
    Holt RI, Goddard JR, Clarke P, Coleman MA. A postnatal fasting plasma glucose is useful in determining which women with gestational diabetes should undergo a postnatal oral glucose tolerance test. Diabet Med. 2003;20(7):594–8.PubMedCrossRefPubMedCentralGoogle Scholar
  105. 105.
    Bottalico JN. Recurrent gestational diabetes: risk factors, diagnosis, management, and implications. Semin Perinatol. 2007;31(3):176–84.PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Emine Aysu Salviz
    • 1
  1. 1.Istanbul University, Istanbul Faculty of Medicine, Department of Anesthesiology and Intensive CareIstanbulTurkey

Personalised recommendations