Journal Mobile

DWM Pearson
Journal Issue: 
Volume 35: Issue 2: 2005




In  women  with  type  1  diabetes  mellitus, meticulous  glycaemic  control, before  and during  pregnancy, usually  results  in  a  healthy  baby.  However, national  and  regional  audits  show poorer outcomes than the background population.  Despite great efforts by mothers and their Diabetes Care Teams, the babies are often large for gestational age, delivered early by Caesarean section (64%), and spend some time in intensive care.  In Scotland, perinatal mortality in diabetic pregnancy  has  reduced  in  recent  years,  but  offspring  continue  to  have  more  congenital abnormalities than the non-diabetic population. The risk of stillbirth and infant mortality are also in excess of the non-diabetic population. In clinical practice, a comprehensive pre-pregnancy and pregnancy care package delivered by a multidisciplinary team to address all risk factors will reduce congenital  anomalies  and  other  adverse  outcomes.  Maintaining  very  tight  control  throughout pregnancy can prove difficult. The management of acute and chronic complications of diabetes is challenging  and  requires  individualised  solutions  underpinned  by  knowledge  of  maternal physiology and the impact of maternal metabolism on the developing fetus and newborn.