Diabetes in pregnancy

Diabetes occurs in approximately 2-5% of all pregnancies. As the UK antenatal population becomes older, more obese and more ethnically diverse the number of pregnant women with pre-existing type 2 diabetes and gestational diabetes will increase. Whether diabetes precedes the pregnancy or arises within it, the risk of accelerated fetal growth, stillbirth and neonatal hypoglycaemia are all increased. As a generalization, adverse pregnancy outcomes increase with increasing maternal glycaemia. Hyperglycaemic-mediated oxidative stress has been implicated as a cause for the increased congenital malformation rates and early fetal loss associated with diabetic pregnancies. While fetal hyperinsulinaemia, secondary to maternal hyperglycaemia, is the cause of accelerated fetal growth and neonatal hypoglycaemia. Achieving optimal maternal glycaemic control prior to and throughout pregnancy is a pivotal goal in the management of all diabetic pregnancies. This degree of control requires all diabetic women contemplating a pregnancy to have access to preconception counselling and being managed with intensive insulin regimens throughout pregnancy. The medical and obstetric surveillance of pregnant diabetic women should be undertaken in a specialized multidisciplinary clinic, where diabetic complications, such as retinopathy and nephropathy, can be regularly assessed, as can fetal growth and development. As birth trauma and stillbirth are all more frequent in diabetic pregnancies elective delivery between 38-39 weeks is usually advised. At birth there is an increased risk of transient metabolic disturbances and in later life an increased risk of adolescent obesity, the metabolic syndrome and type 2 diabetes in young adulthood.