[Diabetes and pregnancy]

During the past years perinatal mortality in diabetic pregnancy has been lowered significantly, in special collections with highly motivated diabetic women even below 2%. In case of optimal metabolic control and absence of diabetic angiopathy the perinatal survival rate is identical to that in normal pregnancy. But adequate metabolic control cannot be reached in all pregnant women during the whole period of gestation, and pre-existing diabetic angiopathy exists frequently; therefore diabetic pregnancy will be associated with elevated perinatal mortality and morbidity also in the future. In case of pre-existing diabetic nephropathy, especially when GFR is decreased before conception there is a high risk for both progression of nephropathy during pregnancy and increased incidence of gestosis and intrauterine growth retardation which lead to earlier delivery (before the 36th week of gestation) in most cases. Perinatal mortality newborns of diabetic women with nephropathy has been decreased significantly during the past years, but perinatal morbidity in these newborns is still high. Pre-existing proliferative retinopathy can show progressive deterioration during pregnancy, but spontaneous regression post partum is usual. In rare cases progression of retinopathy also after delivery has been described even when laser coagulation was performed. Diabetic women with macroangiopathy, especially with coronary artery disease show a high risk for cardiovascular events during pregnancy. The occurrence of acute myocardial infarction in pregnant diabetic women is associated with elevated fetal and maternal mortality. Though there are case reports in the literature describing a successful fetal and maternal outcome after myocardial infarction during pregnancy.