Pre-existing type I and type II diabetes in pregnancy

Diabetes mellitus is a long term chronic condition. The prevalence of diabetes in pregnancy is 2–5% in the UK of both gestational diabetes and pre-existing diabetes. The pregnancy outcomes for pre-existing type I and type II diabetic women are worse than for non-diabetic mothers. There is a higher incidence of stillbirth, macrosomia and congenital malformations. Pre-pregnancy counselling is essential to prepare for pregnancy, to tighten glycaemic control and review medication prior to pregnancy. Multi-disciplinary care is required throughout the antenatal period, to optimise blood glucose monitoring and control. Screening for diabetic complications such as nephropathy and retinopathy is necessary at every trimester to detect progression of disease. The timing, mode and management of delivery with a plan to maintain glycaemic control during this time should be discussed by 36 weeks. After completion of 38 weeks' gestation, induction of labour may be considered. This review will discuss the management of pre-existing type I and type II diabetic women from the preconception period to the postpartum period.