Management of diabetic pregnancy.

The overall aim ofthe diabetic mother, her relatives and all members of the health care team is the safe delivery of a normal, healthy infant at term, preferably by vaginal delivery. This should be achieved with the minimum psychological and physical trauma, inconvenience and risk to the mother. Seen from another angle, avoidance of the many adverse pregnancy outcomes is the primary purpose of the intensified care offered to diabetic women undertaking pregnancy. These include spontaneous abortion and stillbirth, congenital malformation, macrosomia and biochemical disturbance in the neonate along with numerous aspects of maternal morbidity. Fortunately, most of these are wholly or partially ameliorated by optimal glycaemic control. The crucial aim of modern diabetes management in pregnancy is therefore normoglycaemia, though there are numerous other roles for-the health care team. Gestational diabetes is covered separately, though many of the issues are as relevant as they are to 'pregestational' diabetes. There is enormous laboratory research interest in the area of diabetes and pregnancy, but most of our knowledge about practical management comes from clinical and epidemiological studies which are therefore the main focus of this review.