Diabetes Mellitus in Pregnancy: Implications for Obstetric Anesthesia

Diabetes in pregnancy is a common obstetric comorbidity that increases the risks of pregnancy-specific complications. The authors describe in this review how understanding ambulatory use of insulin can impact peripartum anesthesia care. Additionally, they describe the appropriate delivery, dosing, and timing of insulin during birth as relevant for anesthesiologists. They discuss the indications and limitations of technologies such as continuous glucose monitors and insulin pumps in pregnancy, and describe their relevance and appropriate management in the perioperative and peripartum period. Finally, the authors review the unique complication of euglycemic diabetic ketoacidosis and provide appropriate management strategies, as anesthesiologists may be in a position to recognize this complication that could otherwise be overlooked.