Maternal medical conditions part II: Diabetes, asthma, and factor V Leiden studies that changed practice

Abstract

Maternal medical conditions are associated with significant obstetric complications including preterm birth and hypertensive disorders of pregnancy as well as impacting maternal health. This manuscript focuses on the evidence based advances in diabetes, asthma, and the presence of Factor V Leiden mutation in pregnancy that have changed practice. Large randomized controlled trials of mild gestational diabetes addressed the longstanding controversy concerning the benefit for the identification and treatment of GDM by demonstrating the benefit of treatment in pregnancy. Trials of medical management of diabetes in pregnancy provided the data for glyburide and metformin as compared to insulin. Addressing the need for evidence based data for treatment of asthma in pregnancy, a large trial demonstrated the benefit of inhaled steroids for the treatment of asthma in pregnancy. The Factor V Leiden study provided the needed data that the risk of thromboembolic events in untreated heterozygotes for the FVL mutation without evident risk factors for thrombosis is low and is not different from noncarriers. pivoting providers from routine universal screening for FVL mutation. These seminal trials demonstrate that evidence based management in pregnancy is not only feasible, but is essential to ensure the interventions are beneficial.