Implications for the Mother

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Until the discovery of insulin by Banting and Best in 1921, very few women with diabetes became pregnant spontaneously, and even fewer achieved a successful pregnancy outcome. At that time, about 50% of women died during pregnancy from diabetes-related complications (mainly ketoacidosis) and about 50% of the fetuses failed to develop in utero. Later studies documented a much higher rate than expected of both maternal and fetal complications in diabetic pregnancy compared to normal pregnancy.  Diabetic women have a markedly higher risk for a number of pregnancy adverse events, including spontaneous abortion, preterm labour, recurrent genital and urinary tract infections, pyelonephritis, polyhydramnios, hypertensive disorders, traumatic birth and hyper- and hypo-glycemic events. These complications, together with the increased rate of vascular alteration (retinopathy and nephropathy) along with a higher cesarean section rate, contribute to higher maternal morbidity and mortality among diabetic patients. However, once the major issue is addressed - namely, that the diagnosis of gestational diabetes mellitus is thought to be associated with a high risk of developing diabetes in later life - efforts should be made to prevent or ameliorate the emergence of this complication. Women with diabetic pregnancy today are enjoying the benefits of the extraordinary progress made in all areas of medicine in general and in obstetrics in particular.  State-of the art tools have been developed for diagnosis, treatment and follow-up of both mother and fetus, such as fetal heart rate monitors, ultrasonography, and glucose self-monitors and insulin pumps. As a result, leading medical centres worldwide report a major reduction in maternal and fetal complications of diabetic pregnancy to levels similar to those in normal pregnancy. Clinicians today recognize unequivocally that early diagnosis, adequate treatment, and close follow-up are essential to eliminate most complications of diabetic pregnancy and achieve a successful outcome. However, even in developed countries the overall results are far from good.