- Part 1 Principles of international endocrine practice
- Part 2 Pituitary and hypothalamic diseases
- Part 3 The thyroid
- Part 4 Parathyroid, calcium, and bone metabolism
- Part 5 The adrenal gland and endocrine hypertension
- Part 6 Neuroendocrine tumours and genetic disorders
- Part 7 Growth and development during childhood
- Part 8 Female endocrinology and pregnancy
- Part 9 Male hypogonadism and infertility
- Part 10 Endocrinology of ageing and systemic disease
- Part 11 Endocrinology of cancer
- Part 12 Obesity, lipids, and metabolic disorders
- Part 13 Diabetes mellitus
- 13.1 Classification and diagnosis of diabetes mellitus
- 13.2 Aetiology and pathogenesis of type 1 diabetes mellitus
- 13.3 Aetiology and pathogenesis of type 2 diabetes mellitus
- 13.4 Management of diabetes mellitus
- 13.4.1 Clinical features, lifestyle management, and glycaemic targets in type 2 diabetes mellitus
- 13.4.2 Pharmacological therapy of hyperglycaemia in type 2 diabetes mellitus
- 13.4.3 Diabetes in diverse ethnic groups
- 13.4.4 Structured education for people with type 2 diabetes mellitus
- 13.4.5 Metabolic surgery in the treatment of type 2 diabetes mellitus
- 13.4.6 Management of type 1 diabetes mellitus
- 13.4.7 Type 1 and type 2 diabetes mellitus in children
- 13.4.8 Hypoglycaemia in the treatment of diabetes mellitus
- 13.4.9 Non-biological technologies in glucose sensing
- 13.4.10 Management of diabetes mellitus in special situations
- 13.4.10.1 Hyperglycaemic crises in adult patients with diabetes mellitus
- 13.4.10.2 Diabetic ketoacidosis in childhood and adolescence
- 13.4.10.3 Management of the inpatient with diabetes mellitus
- 13.4.10.4 Insulin therapy in the intensive care unit
- 13.4.10.5 Diabetes management in surgery
- 13.4.10.6 Diabetes management in pregnancy
- 13.5 Microvascular complications
- 13.6 Macrovascular diseases and diabetes mellitus
- 13.7 The diabetic foot
- 13.8 Mental health and diabetes mellitus
- 13.9 Organization of diabetes care
- 13.10 Transplantation in Diabetes
- 13.11 Gene therapy in diabetes mellitus
Diabetes management in pregnancy
- Chapter:
- Diabetes management in pregnancy
- Author(s):
David R. McCance
- DOI:
- 10.1093/med/9780199235292.003.1499
Although the outlook for the woman with diabetes has greatly improved since the discovery of insulin, the goal of the St. Vincent Declaration (1989) that the outcome of diabetic pregnancy should approximate that of nondiabetic pregnancy has still not been realized. In the mid 1990s, a number of regional UK centres reported a four-fold to ten-fold increase in congenital malformations and three- to five-fold increase in perinatal mortality, compared with the background population. A general increase in the prevalence of type 2 diabetes is being translated into the pregnancy context and outcomes appear similar to those of type 1 diabetes. The problem of pregnancy planning and other key demographic and pregnancy-related features were highlighted in a major UK Confidential Enquiry into Maternal and Child Health (CEMACH) during 2002–2003, which has provided a largely unrivalled source of reference (1). While the relevance of overt hyperglycaemia to maternal and perinatal outcomes is now clearly established, the significance of minor degrees of hyperglycaemia for maternal/fetal outcome has been the subject of much controversy and dogma. The lack of a robust evidence base is reflected in the lack of consensus among published guidelines (2).
Despite these limitations, the outcome of pregnancy for most women with diabetes is good, and this undoubtedly reflects improved obstetric surveillance and better management of maternal hyperglycaemia over the last several decades. The aim is, through education and maternal empowerment, to optimize blood glucose control both before and during pregnancy, so that pregnancy may proceed as normally as possible and result in the birth of a normal baby at near term.
The last few years have seen the publication of a number of landmark observational studies and randomized trials (3–8), which have the potential to alter the diagnostic and therapeutic landscape considerably. Some guidance for the management of diabetes in pregnancy has recently been published (9, 10).
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- Part 1 Principles of international endocrine practice
- Part 2 Pituitary and hypothalamic diseases
- Part 3 The thyroid
- Part 4 Parathyroid, calcium, and bone metabolism
- Part 5 The adrenal gland and endocrine hypertension
- Part 6 Neuroendocrine tumours and genetic disorders
- Part 7 Growth and development during childhood
- Part 8 Female endocrinology and pregnancy
- Part 9 Male hypogonadism and infertility
- Part 10 Endocrinology of ageing and systemic disease
- Part 11 Endocrinology of cancer
- Part 12 Obesity, lipids, and metabolic disorders
- Part 13 Diabetes mellitus
- 13.1 Classification and diagnosis of diabetes mellitus
- 13.2 Aetiology and pathogenesis of type 1 diabetes mellitus
- 13.3 Aetiology and pathogenesis of type 2 diabetes mellitus
- 13.4 Management of diabetes mellitus
- 13.4.1 Clinical features, lifestyle management, and glycaemic targets in type 2 diabetes mellitus
- 13.4.2 Pharmacological therapy of hyperglycaemia in type 2 diabetes mellitus
- 13.4.3 Diabetes in diverse ethnic groups
- 13.4.4 Structured education for people with type 2 diabetes mellitus
- 13.4.5 Metabolic surgery in the treatment of type 2 diabetes mellitus
- 13.4.6 Management of type 1 diabetes mellitus
- 13.4.7 Type 1 and type 2 diabetes mellitus in children
- 13.4.8 Hypoglycaemia in the treatment of diabetes mellitus
- 13.4.9 Non-biological technologies in glucose sensing
- 13.4.10 Management of diabetes mellitus in special situations
- 13.4.10.1 Hyperglycaemic crises in adult patients with diabetes mellitus
- 13.4.10.2 Diabetic ketoacidosis in childhood and adolescence
- 13.4.10.3 Management of the inpatient with diabetes mellitus
- 13.4.10.4 Insulin therapy in the intensive care unit
- 13.4.10.5 Diabetes management in surgery
- 13.4.10.6 Diabetes management in pregnancy
- 13.5 Microvascular complications
- 13.6 Macrovascular diseases and diabetes mellitus
- 13.7 The diabetic foot
- 13.8 Mental health and diabetes mellitus
- 13.9 Organization of diabetes care
- 13.10 Transplantation in Diabetes
- 13.11 Gene therapy in diabetes mellitus