Types 1 and 2 diabetes in pregnancy present multiple challenges to healthcare groups. Although there are debates regarding the precise pathophysiology of the different complications of diabetes during pregnancy, there is increasing evidence that good pre-conception and early pregnancy glycaemic control will reduce the rate of all complications, including macrosomia. The relationship between malformation and blood glucose levels may differ for different malformations.
The provision of organised pre-pregnancy care for this group allows an opportunity to reinforce the need for tight glycaemic control, commence vitamin supplementation, identify those with complications of diabetes who require more specialist evaluation and preparation, and to inform women of pregnancy risks. How this type of detailed care is provided is a major organisational issue for all healthcare systems. Current UK provision falls short.
Many interventions and strategies during pregnancy, including the degree of glycaemic control, have a poor evidence base. Short-term variation of glucose values across the day may contribute to morbidity in apparently well-controlled diabetes. Novel strategies will be required to reduce this. The demands on pregnant women with pre-conception diabetes should not be underestimated.
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