Novel insights into the management of diabetes in pregnancy

Abstract

Since maternal diabetes mellitus (DM) is no longer regarded as a contraindication for pregnancy, obstetricians, pediatricians and internists have dealt with its considerable impact on maternal and perinatal outcomes. Many obstetric morbidities, such as congenital malformations, stillbirths or macrosomia, are related to poor glycemic control. Fortunately, improvements in the management of diabetes and in perinatal care have improved maternal and fetal perspectives. This led the World Health Organization Europe and the International Diabetes Federation Europe to set common goals in the Saint Vincent Declaration in 1989, aiming at pregnancy outcomes in diabetic women equaling those of healthy women. Unfortunately and despite much effort, diabetic pregnancies are still at increased risk of adverse outcomes. In addition, the worldwide obesity epidemic and the consequent excess of hyperglycemia have resulted in a rising prevalence of DM2 and GDM, urging to clarify controversies and improve outcomes. In this thesis, novel insights into the diagnosis, management and outcomes of diabetes in pregnancy are presented, including the results of a national randomized controlled trial (RCT) on intermittent use of CGM in diabetic pregnancy.