Diabetes in Pregnancy

Although there have been many advances in the treatment of diabetes, the goal of the St. Vincent Declaration (1989) that the outcome of diabetic pregnancy approximates that of non-diabetic pregnancy has still not been realized. Women with diabetes still have an increased risk of pregnancy-related complications including preterm delivery, large-for-gestational-age, neonatal hypoglycaemia, congenital anomaly, stillbirth, and neonatal death. The landscape of diabetes in pregnancy has changed dramatically with one in six pregnancies affected by maternal hyperglycaemia. Approximately half of all women with pre-gestational diabetes in pregnancy now have pre-gestational type 2 diabetes (T2D). This represents a 90% increase in the proportion of pregnancies complicated by T2D over 15 years. Likewise, recent data suggest a 44% increase in the number of pregnancies complicated by type 1 diabetes (T1D). While there remains much room for improvement, pregnancy outcomes for most women with diabetes are good. This likely reflects improvements such as obstetric surveillance, tighter glycaemic targets, improved diabetes technologies, and specialized interdisciplinary teams. There is also evidence of recent improvements, with a 2.5-fold reduction in stillbirths in a large contemporary UK cohort of women with pre-gestational diabetes in pregnancy compared to 15 years earlier. The goal now is to further improve pregnancy outcomes in women with diabetes by optimizing pre-pregnancy care, glycaemic control, and obstetric and diabetes-related surveillance using targeted education, technology, specialized teams, and by empowering women with diabetes.