Diabetes is one of the most common medical conditions to complicate
pregnancy. Gestational diabetes (diabetes with onset or first
recognition in pregnancy) may complicate between 2 and 20% of
pregnancies depending on the criteria used. Type 1 or Type 2
diabetes complicates over 1 in 300 pregnancies, and both have major
implications for mother and child. The management of diabetes
during pregnancy has seen a number of major innovations in recent
years. Insulin analogues have been introduced, and technical
innovations include improvements in insulin pumps and the
development of continuous glucose monitoring devices. The evidence
base for the management of gestational diabetes has improved
markedly, and the investigations based around the Hyperglycaemia
and Adverse Pregnancy Outcomes (HAPO) study promise to
revolutionise our understanding of the risks of adverse outcomes in
pregnancy. The Australian Carbohydrate Intolerance Study (ACHOIS)
has demonstrated that identification and glycaemic management of
gestational diabetes leads to reduction in birth weight, macrosomia
and adverse pregnancy outcomes. Finally, recent randomised control
trials have explored use of oral hypoglycaemics (metformin,
glibenclamide) in pregnancy. Part of the Oxford Diabetes Library
series, 'Diabetes in Pregnancy' summarizes the key aspects of the
medical management of diabetes during pregnancy with an emphasis on
clinical management. The volume is designed for all members of the
multidisciplinary team and will act as a practical introduction
particularly for obstetricians and endocrinologists in training.
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