title: Diabetes in pregnancy.
abstract: Diabetes in pregnancy is still considered a high-risk condition for both mother and baby. Even in the best centres, malformation and mortality rates are reportedly twofold to fivefold higher than in the background population, and pregnancy planning rates remain obstinately poor. Increasing global rates of type 2 diabetes are now extending into pregnancy, with similarly poor outcomes to type 1 diabetes, and excess maternal weight is adding to the complexity of management. Over the last 5-10 years, several randomised trials have offered new insight into the role of oral hypoglycaemic drugs and insulin analogues in pregnancy, while continuous subcutaneous insulin infusion (CSII) pumps and continuous glucose monitors (CGMs) are under scrutiny. The relevance of minor degrees of hyperglycaemia to adverse pregnancy outcome was clearly demonstrated by the Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) study, but translation of these data into clinical practice has proved challenging because of the continuum of risk. Long-term metabolic and cardiovascular implications of hyperglycaemia during pregnancy for mother and child are now generally recognised with major implications for public health.
authors.affiliation: Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast BT12 6BA, Northern Ireland, UK. Electronic address: david.mccance@belfasttrust.hscni.net.
authors.forename: David R
authors.initials: DR
authors.lastname: McCance
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D000013:Congenital Abnormalities / Q000209:etiology; D036861:Delivery, Obstetric; D048909:Diabetes Complications / Q000209:etiology*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D016640:Diabetes, Gestational / Q000175:diagnosis / Q000188:drug therapy*; D037001:Directive Counseling; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D016742:Preconception Care; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000628:therapy*
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human
keywords: diabetes; gestational diabetes mellitus; obesity; outcome; pregnancy