Clinical perspectives in the care of the pregnant diabetic patient.
Despite the considerable improvement in the care of the diabetic mother and the prognosis for her baby, a number of clinical problems remain unresolved. Apart from the increased incidence of major and minor fetal anomalies, morbidity amongst the newborn and the high incidence of diabetes in later life of women who have had relatively minor carbohydrate intolerance during pregnancy are a cause for concern. In this paper the outstanding clinical problems and thier possible solutions are considered. The elucidation of the origin of congenital malformations is discussed. The prevention of congenital anomalies in the diabetic requires a precise knowledge of their aetiology which is currently not available. However, on the hypothesis that diabetes creates an abnormal biochemical environment which may well disturb embryogenesis, it is logical to try and control maternal blood sugar as soon as possible in pregnancy or even before conception. To extend this argument further, it follows naturally that the maintenance of normoglycaemia throughout pregnancy until delivery is also desirable. The practicalities of various methods of screening for diabetes in pregnancy and new approaches in the medical and obstetric problems of the pregnant diabetic are also considered. Finally, the question of contraception and its implication for the woman who is known to have carbohydrate intolerance in pregnancy is discussed.
D000013:Congenital Abnormalities / Q000209:etiology / Q000517:prevention & control*; D003276:Contraceptives, Oral; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008403:Mass Screening; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000175:diagnosis / Q000628:therapy*; D011296:Prenatal Diagnosis
D003276:Contraceptives, Oral