Babies born after diabetes in pregnancy: what are the short- and long-term risks and how can we minimise them?
Despite improvements in services for people with diabetes and an increased focus on care of diabetes in pregnancy, there has been no significant reduction in neonatal complications after pregnancy complicated by maternal diabetes. Some complications are severe and life threatening or lead to long-term difficulties, whilst others are transient and are unlikely to lead to long-term harm, if managed according to standard guidelines. Most neonatal complications are, in theory, avoidable by optimal diabetes care, those that arise directly as a result of poor control of diabetes in pregnancy or as a result of obstetric interventions related to maternal diabetes control. Of greater concern are iatrogenic complications that arise from decisions which have no clear rationale (e.g., 'routine' admission of a baby to a neonatal unit). Planning for neonatal management must take into account known risks and the likelihood of occurrence, start in advance of delivery, involve all relevant groups of professionals and be centred on the needs of the mother and baby and not upon historical organisational policies.
University College London Hospitals, UK. jane.hawdon@uclh.nhs.uk
J M
JM
Hawdon
D000013:Congenital Abnormalities / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000628:therapy; D016640:Diabetes, Gestational / Q000503:physiopathology* / Q000628:therapy; D005260:Female; D005315:Fetal Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology / Q000517:prevention & control; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000517:prevention & control; D018743:Perinatal Care; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011254:Pregnancy in Diabetics / Q000503:physiopathology* / Q000628:therapy; D011295:Prenatal Care; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D012307:Risk Factors