Endocrine Abstracts

Diabetic mothers have an increased risk for pregnancy (early pregnancy loss, polyhydramnios, pre-eclampsia, premature labor) and progression of diabetic complications. We present a case of the progression of diabetic-related complications including autonomic neuropathy (AN) which caused severe vomiting during pregnancy. A 27-year-old type 1 diabetic woman with pregnancy of 8 weeks gestational age (GW) was admitted to our hospital for glycemia and diabetic-related complications control. She has had diabetes for 13 years. The control of diabetes was poor (HbA1c 9.13%). She was already diagnosed with multiple diabetes-related complications (nonproliferative diabetic retinopathy and maculopathy, polyneuropathy, nephropathy). An insulin-pump therapy was started to achieve a better glycemia control during pregnancy. The minor progression of albuminuria was noticed during first hospitalization. Around 11 GW she was hospitalized for the second time because of the sudden blood pressure (BP) elevation (160/110 mmHg), nausea, vomiting, headache, glycemia variability. The progression of diabetic nephropathy was observed, antihypertensive (AH) drugs for the treatment of secondary hypertension were started. Despite the better glycemia control which was achieved (HbA1c 6.1%) in few months, the patient was hospitalized for the other nine times during the pregnancy. The main complains were severe nausea, vomiting, BP elevation and ketonemia. The progression of all diabetes-related complications was observed. The maximum doses of AH drugs were required for management of BP. Albuminuria progressed to nephrotic level, hypoalbuminemia and hypoproteinemia occured. Diabetic retinopathy developed to proliferative. Severe vomiting led to electrolytes dis-balance. Nausea and vomiting was considered to be caused by the progression of AN, when other possible causes were excluded. At 36 GW during planned C-section a healthy girl was born (Abgar 8/8). Poor control of diabetes may lead to the severe progression of the diabetes–related complications. The progression of diabetic autonomic neuropathy remains forgotten in many cases during pregnancy.