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Improving outcomes in diabetes in pregnancy
The Practitioner
|June 4, 2016
Summary
Diabetes in pregnancy, including gestational diabetes, significantly increases risks like stillbirth and birth defects. Achieving good blood glucose control before conception and managing gestational diabetes through lifestyle changes are crucial for better outcomes.
Area of Science:
- Obstetrics and Gynecology
- Endocrinology
- Public Health
Background:
- Diabetes affects 1 in 250 pregnancies in the UK, with gestational diabetes being the most common form.
- Pregnancy with diabetes carries substantially higher risks of stillbirth (5x) and congenital defects (2x).
- Elevated fasting blood glucose (>5.3 mmol/L) negatively impacts fetal organ development, while hyperglycemia can lead to placental failure and stillbirth.
Purpose of the Study:
- To highlight the risks associated with diabetes in pregnancy.
- To emphasize the importance of pre-conception blood glucose control for women with pre-existing diabetes.
- To outline management strategies for gestational diabetes and long-term risks.
Main Methods:
- Review of current understanding of diabetes in pregnancy.
- Analysis of risks associated with hyperglycemia during pregnancy.
- Discussion of recommended glycemic targets (HbA1c <48 mmol/mol) for pre-conception and management of gestational diabetes.
Main Results:
- Good pre-conception glycemic control can reduce pregnancy risks.
- Strict glycemic targets (HbA1c <48 mmol/mol) are recommended before pregnancy; pregnancy is strongly discouraged with HbA1c ≥86 mmol/mol.
- Gestational diabetes results from inadequate insulin compensation for pregnancy-induced insulin resistance.
Conclusions:
- Effective management of diabetes in pregnancy requires early intervention and specialist input.
- Lifestyle modifications are key for gestational diabetes management.
- Women with gestational diabetes require lifelong annual screening for type 2 diabetes due to their increased lifetime risk.
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