Diabetes mellitus in pregnancy: have all the problems been solved?

The past decade has seen a remarkable improvement in the prognosis for the pregnancy complicated by diabetes mellitus. Perinatal survival has become as common in these pregnancies as in normal ones. This improved outcome has been achieved through a better understanding of maternal metabolism and the needs to regulate maternal glycemia carefully as well as through reliable techniques for the surveillance of fetal well-being and advances in neonatal care. Significant perinatal morbidity still occurs, and congenital malformations--the leading cause of perinatal mortality today--remain an unresolved problem. Maternal outcome must also be considered. Uncertainty remains regarding the course of retinopathy in pregnancy, and the small group of diabetic women with coronary artery disease do appear to be at increased risk for mortality during gestation. A systematic screening program for gestational diabetes must now be adopted.