Diabetes in pregnancy. No longer a barrier to successful outcome

There are three key goals in current management of the diabetic pregnancy. Normal diabetes control before conception and during the first trimester in an attempt to reduce the incidence of congenital abnormalities. This implies that all diabetic women of childbearing age should have counseling before pregnancy. Routine use of new techniques such as home blood glucose monitoring, intensified conventional insulin regimens, or an insulin infusion pump for maintenance of tight metabolic control both before and during pregnancy. Delay in delivery of the baby until the due date, assuming good diabetes control and normal antepartum monitoring of the fetus, to reduce the incidence of macrosomatia, decrease the rate of cesarean section, and decrease neonatal mortality. The current outlook for the pregnant woman with diabetes is an optimistic one. Until recently, most women with diabetes were told that they should avoid pregnancy. Sterilization was often suggested as a means of contraception. Unfortunately, some women are still getting that message from their physician. This is unacceptable, as it is obvious that diabetes is no longer a barrier to pregnancy. Most women with diabetes can now consider the possibility of pregnancy and know that they have a reasonable chance of having a healthy child. Furthermore, new developments in diabetes care continue and should lead to an even brighter future for this group of patients. New advances in treatment, such as implantable insulin pumps, glucose sensors, and islet cell transplants, are just over the horizon. With these developments, a woman with diabetes will be freed from the intensive regimen she must now practice to achieve a successful pregnancy.