The key elements in management of pregnancies complicated by diabetes are:
- Achieving and maintaining excellent glycemic control
- Screening, monitoring, and intervention for maternal medical complications (eg, retinopathy, nephropathy, hypertension, cardiovascular disease, ketoacidosis, thyroid disease)
- Monitoring of, and intervention for, fetal and obstetrical complications (eg, congenital anomalies, preeclampsia, macrosomia)
Most issues related to the obstetrical management of a pregnant diabetic woman (type 1 or type 2) will be reviewed here. The obstetrical management of these pregnancies is largely based upon clinical experience, data from observational studies, and expert opinion [1,2]. There is virtually no evidence from randomized trials.
Four important additional issues are discussed in detail separately: prepregnancy counseling, glycemic control, maternal medical complications, and neonatal issues: