Diabetes in pregnancy: a review of current evidence.
OBJECTIVE
There is controversy about the best approach to screening and management for gestational diabetes. In the recent Confidential Enquiry in Maternal and Child Health (CEMACH) the outcome of women with diabetes compared with women without diabetes. The results were exceptionally poor, suggesting the need for a new management approach. The aim of this review is to address these findings and our suggested care pathways.


RESULTS
The CEMACH report showed the congenital malformation rate was four to 10-fold higher, the perinatal mortality rate was four to seven-fold higher, stillbirth was five times more common, and babies were three times more likely to die in the first 3 months of life. Only 39% of women with established diabetes took folic acid and only 37% had some documentation of glycaemic control before pregnancy. Overall, less than a fifth of NHS trusts in the UK had any kind of multidisciplinary preconception services. The results for women with type 2 diabetes were as bad as those for type 1. Caesarean delivery rates were very high (67%).


CONCLUSIONS
Prepregnancy counselling and multidisciplinary team management is the key in achieving good pregnancy outcomes. There is emerging evidence about the safety and efficacy of oral hypoglycaemics like metformin in pregnancy.
Kapoor
Nisha
N
Maternal Medicine Unit, Epsom & St Helier University Hospitals NHS Trust, Surrey, UK. hassan.shehata@nhs.net
Sankaran
Srividhya
S
Hyer
Steve
S
Shehata
Hassan
H
D002585:Cesarean Section / Q000379:methods; D000013:Congenital Abnormalities / Q000453:epidemiology*; D016640:Diabetes, Gestational / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy; D004032:Diet; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007226:Infant Mortality; D007231:Infant, Newborn; D010346:Patient Care Management; D011247:Pregnancy; D011256:Pregnancy Outcome; D011254:Pregnancy in Diabetics / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy; D011295:Prenatal Care / Q000379:methods*; D012307:Risk Factors
D007004:Hypoglycemic Agents