Management problems in the pregnant diabetic

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Abstract
Major progress has been made in the knowledge and management of diabetes and pregnancy. However diabetes in pregnancy remains an important medical complication, with implications for mother and child in both the short and the long term. There are still controversies concerning the diagnostic criteria of gestational diabetes and concerning the best strategry for the treatment of this disorder. There is even less agreement about whether gestational diabetes is a pathological condition. The perinatal mortality in gestational diabetes has recently become as low as that in the general population. This has led to the conclusion that gestational diabetes is no more than a variant of metabolic adaptation during pregnancy. However, fetal hyperinsulinism is present in gestational diabetes, resulting in macrosomia, neonatal complications and most probably long term consequences. Improvements in the care of the preexisting insulin-dependent pregnant diabetic have been achieved but further progress in understanding the underlying mechanisms and in preventing and treating the disease are important goals for the near future.

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