Pregnancy and diabetes

Despite improved obstetric surveillance and better management of maternal hyperglycaemia over the last few decades, perinatal mortality and congenital malformation rates remain several fold higher in pregnancy complicated by diabetes than in the background population. A worldwide increase in the prevalence of type 2 diabetes is now being realized in the pregnancy context with apparently similar or even worse outcomes to type 1 diabetes. While the relevance of periconceptual glycaemic control to maternal fetal outcome is clearly established, only around half of women with type 1 diabetes plan their pregnancy and rates are even lower in type 2 diabetes. In the last 5–10 years, several landmark trials have pointed to the validity of gestational diabetes mellitus as a diagnostic entity, however translation of recently published consensus guidelines for diagnosis and screening into routine clinical practice may prove challenging. An expanding therapeutic armamentarium and increasing awareness of the long-term implications of diabetic pregnancy for both mother and child present new challenges for clinical care, research and public health.