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Diabetes management in pregnancy 

Diabetes management in pregnancy
Chapter:
Diabetes management in pregnancy
Author(s):

David R. McCance

DOI:
10.1093/med/9780199235292.003.1499
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date: 13 November 2019

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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