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Pre-gestational diabetes mellitus (DM) is associated with adverse fetal and maternal outcomes. We have previously reported outcomes for women with DM. To determine whether review, and discussion of the results, affected outcomes, pregnancies in women with DM from July 1998 to July 2001 were examined in a prospective cohort study. The results were then compared to the results from the previous review. Methods Thirty-five pregnancies were included (24 in 20 women with Type 1 DM, 11 in 11 with Type 2 DM). Type 1 women were more likely to be Caucasian (100% versus 22.2%, p < 0.0001), and had a longer duration of diabetes (13 ± 6 versus 3 ± 2 years, p < 0.0001). Results Pregnancy planning rates improved significantly for Type 1 DM (62.5% planned versus 18.9% in original inal study p = 0.01), and did not change for Type 2 DM. Caesarean section (LSCS) rate was high in the original study, particularly in Type 1 DM (77%), and was lower after review (47.6% in Type 1 DM p < 0.05 compared to original study, and 44.4% in Type2 DM, p = ns). Planning was associated with lower HbA1c before and during pregnancy (6.0 ± 1.4% versus 8.1 ± 1.8% (p = 0.0035), and 5.5 ± 1 versus 6.5 ± 1.5%(p < 0.001)), greater gestational age at delivery (38.2 versus 36.2 weeks p = 0.0318) and lower rate of LSCS (31.6% versus 72.7% (p = 0.0295)). Conclusions It is important to continue improving pre-pregnancy planning. Extensive discussions involving a multi-disciplinary team improved planning rates and decreased the LSCS rate while maintaining outcomes.

SUMMARY Pregestational diabetes mellitus (DM) is associated with adverse fetal and maternal outcomes. Studies suggest that optimal control of diabetes before and during pregnancy minimises these risks. There are few recent reviews of outcomes of pregnancies complicated by DM in Australia. Ninety-three pregnancies in women with DM at our hospital since 1989 were identified. We collected data for maternal age, type of diabetes, duration of therapy, complications of diabetes, maternal complications of pregnancy and fetal outcomes including malformations. The rate of pregnancy planning with optimal glycaemic control at conception was low in our population, particularly in patients with Type 1 diabetes. Women who smoked had worse glycaemic control, and a higher rate of miscarriage. There was a high rate of Caesarean section, particularly in those women with Type 1 diabetes (77.4%). The rate of Caesarean section was lower in planned pregnancies. There were no perinatal deaths. The number of neonates with major congenital anomalies was high (13%) in the Type 1 population. It is important to increase the rates of prepregnancy planning and to optimise glycaemic control before pregnancy. In many cases there has been a long interval between diagnosis and pregnancy, so all women with diabetes should receive counselling at frequent intervals about pregnancy and the importance of planning. Women who planned their pregnancies had improved outcomes, with decreased rate of Caesarean section, better glycaemic control and better neonatal Apgar scores. Women with diabetes should not smoke during pregnancy because of the increased risk of miscarriage and poorer glycaemic control.

Objective Preeclampsia (PreE) is one of considerable public health threat particularly in developing countries globally affecting approximately 8% of all pregnancies. PreE is a pregnancy-specific condition that increases maternal and infant mortality and morbidity, but the etiology remains unknown. Despite numerous basic, clinical, and epidemiologic studies that have been conducted over the past half century, knowledge of the etiology and pathogenesis of preeclampsia remains elusive. It is diagnosed by new onset increased blood pressure and proteinuria during second or third trimester of gestation; key features of the preeclampsia category include a cut-off blood pressure of 140/90 mm Hg or higher and absolute requirement of proteinuria. Approximately 20% of the diabetic pregnant women develop preE. The mechanisms contributing to this effect is not well characterized. In a recent study, we have shown that hyperglycemia impairs cytotrophoblast (CTB) function via stress signaling. Several researchers demonstrate a direct link between preE and diabetes. The objective of the study was to evaluate potential linkage between the risk of developing preE and the presence of diabetes in pregnant patients in Bangladesh. Methods This is a cross-sectional study of 351 pregnant women performed to evaluate the prevalence of PreE with respect to different risk factors such as previous pregnancy, presence of Antiphospholipid antibodies, pre-existing diabetes (before this pregnancy), multiple gestation / singleton, family history of preE in first degree relative (mother, sister and daughters; most commonly mother), maternal age of 40 or greater. The study was conducted in selected hospitals of Dhaka city, Bangladesh during December 2013 to December 2015. Results The key study findings revealed that the overall rate of development of PreE in Bangladeshi pre-gestational diabetic patients is 22.6 percent. We gave special emphasis on the occurrence of PreE in pre-gestational diabetic patients. Among 351 respondents, 145 Patients (25.5%) with either DM prior to pregnancy or developing gestational diabetes or without diabetes were older (age >35 years) pregnant women (13.1%). Prevalence of PreE is 25.5 (n=145) and 19.6 (n=199) percent among those who developed pre-gestational diabetes and without diabetes prior to pregnancy. Of the respondents 17.2 percent have both systolic and diastolic hypertension those who developed DM prior to this pregnancy and 13 percent among those who does not developed DM prior to this pregnancy. Occurrence of abortion was up to 3 percentage before this pregnancy 45 percentage who developed DM prior to this pregnancy and 35 percent who does not have diabetes among the respondents. Conclusions There is an association has been found between the risk of developing preE and the presence of diabetes in pregnant patients in Bangladesh.

AIM: To explore the additional risk of stillbirths and to quantify that risk according to gestational age among women with diabetes. METHODS: Data on pregnancies ending in 2007 and 2008 in women with pre-gestational diabetes in three English regional audits were identified. A prospective audit collected data on all pregnancies delivering between June 2010 and May 2011 in one region and in 13 other units across England. The data on all singleton pregnancies from these two cohorts were combined. Comparisons were made to all births in England and Wales for the same time period using data from the Office for National Statistics. RESULTS: In the cohort of women with pre-gestational diabetes there were a total of 2085 singleton pregnancies, of which 29 resulted in a stillbirth (overall stillbirth rate 13.9 per 1000, 95% CI 9.7-19.9, relative risk compared with all pregnancies in England and Wales 2.73, 95% CI 2.61-2.84). The relative risk of stillbirth between 32 and 34 weeks' gestation was 4.95 (95% CI 4.24-5.78), 3.77 (95% CI 3.42-4.16) at 35 to 36 weeks, 5.75 (95% CI 5.43-6.09) for deliveries at 37 or 38 weeks and 7.34 (95% CI 6.52-8.25) for those born at 39 weeks or more. CONCLUSION: Women with diabetes have a significantly higher risk of stillbirth at all gestations after 32 weeks and this additional risk is not just confined to pregnancies at 37 weeks or more.

Objective: To determine the incidence of antenatal and intrapartum maternal and fetal complications of gestational diabetes mellitus (GDM) and compare them with pre-gestational diabetes mellitus (pre-GDM) and non-diabetic pregnancies in our population. Study design: Nine-hundred and seventy-two women with gestational diabetes mellitus and 71 women with pre-gestational diabetes mellitus, and their offspring (delivered in our hospital between January 1991 and April 1994) were studied. Maternal and fetal prenatal and intrapartum complications were analyzed. Results: The incidence of GDM was 9.8%. The maternal complications included higher incidences of cesarean section and perineal lacerations in GDM and pre-GDM patients than in the non-diabetic pregnancies, and higher rates of macrosomia and hypoglycemic episodes in their offspring. Conclusion: The incidence of maternal, fetal and neonatal complications in GDM is similar to pre-GDM patients and their offspring. Both GDM and pre-GDM pregnancies and the offspring should, therefore, be monitored and managed identically.

Objective: The aim of this study was to investigate thyroid function tests in Gestational Diabetes Mellitus (GDM) and pre-gestational DM and control group. Methodology : There were 61 pregnant diabetic women in study group and 35 pregnant women in control group. Serum T4, T3, T3RU, FTI, TSH and Anti TPO Ab were assessed in each person. Results : About 36% of patients had GDM and 64% pre-gestational DM. Thyroid dysfunction was detected in 18% of study group compared with 8.6% of control group (P = 0.2). There was Thyroid dysfunction in 4.5% of GDM and 25.6% of pregestational DM (P = 0.045). There was no statistically significant difference between thyroid dysfunction in GDM group and control group (P=0.99).27% of GDM and 36% of pregestational DM and 23% of control group had positive titer of Anti TPO Ab without statistically significant differences among the three groups. Conclusion : Thyroid dysfunction is prevalent in women with pre-gestational DM so, thyroid function should be evaluated in these patients during pregnancy. Rate of thyroid dysfunction in GDM patients is similar to normal pregnant control women. High prevalence of positive titer of TPO Ab was seen in diabetic and non-diabetic pregnant women.

Oxidative stress (OS) plays a role in pregnancy at risk of pre-eclampsia, diabetes and premature labour. We measured three markers of OS: total antioxidant capacity (TAC), thiolyte capacity and pro-oxidant capacity in 45 women: 15 normal pregnancies, 17 pathological pregnancies (pre-eclampsia and pregestational diabetes) and 13 delivered pre-term. Plasma TAC (μmol/ml) values in patients with pathological pregnancies (235.67 ± 70.08) (p(1) = 0.0086) and pre-term labour (243.51 ± 50.52) (p(2) = 0.0479) were significantly reduced as compared with the controls (306.78 ± 70.08). Thiolyte capacity (μmol/ml) in the pathological pregnancies (326.03 ± 78.24) (p(3) = 0.0029) and in pre-term labour (335.94 ± 76.63) (p(4) = 0.0084) groups were significantly reduced compared with the control group (417.48 ± 39.76) (p < 0.05). Pro-oxidant capacity (mg/100 ml) in the pathological pregnancies (94.11 ± 26.13) (p(5) = 0.00034) and in pre-term labour (87.18 ± 20.28) (p(6) = 0.00044) groups were significantly higher compared with the controls (60.27 ± 6.33). Elevated OS values were seen in pathological pregnancies. This supports the important role of OS in diseases in pregnancy, particularly pre-eclampsia, diabetes and pre-term birth.

To assess the impact of pre-pregnancy counselling (PPC) on the health of diabetic women in early pregnancy as compared to their health at the time of PPC.Retrospective cohort study involving all the diabetic women who attended PPC and subsequently become pregnant in the decade 1997-2007. The proforma had two sections: one for the PPC visit and one for the booking visit. Details on demographic factors, control and complications of diabetes, folic acid, current medication, weight, contraception, smoking and alcohol consumption were documented.Fifty-seven women who became pregnant after PPC were studied. There was optimisation of diabetic control with a significant reduction in HbA1c levels at booking as compared to PPC (7.5% vs 8.8%, p0.0001). Diabetic surveillance (retinopathy and nephropathy screening) was up to date at the time of booking in80% of the cases. Alteration of insulin regimes was undertaken in ∼ 1 in 5 women. Folic acid was taken by most patients (48/54) at booking. There was no significant reduction in the number of women who smoked at booking compared to PPC.The effect of PPC was evident in the improvements in the markers of health of diabetic women in early pregnancy compared to at the time of PPC.

In the accompanying comment letter (1), Weinert summarizes published data from the Brazilian Gestational Diabetes Study (2) and comments on applying International Association of Diabetes and Pregnancy Study Groups (IADPSG) Consensus Panel recommendations (3) for the diagnosis of gestational diabetes mellitus (GDM) to that cohort. The Brazilian study provided evidence that adverse perinatal outcomes are associated with levels of maternal glycemia below those diagnostic of GDM by American Diabetes Association or World Health Organization criteria. However, the results were potentially confounded by the treatment of GDM. It did find that women with GDM were at increased risk for some …

Aim To determine population-based rates and outcomes of pre-gestational diabetes mellitus (pre-GDM) and gestational diabetes mellitus (GDM) in pregnancy. Methods This was a cross-sectional study, using linked population databases, of all women, and their infants, discharged from hospital following birth in New South Wales (NSW) between 1 July 1998 and 31 December 2002. Women with, and infants exposed to pre-GDM or GDM were compared with those without diabetes mellitus for pregnancy characteristics and outcomes. Results Women with a singleton pregnancy (n = 370 703) and their infants were included: 1248 women (0.3%) had pre-GDM and 17 128 (4.5%) had GDM. Of those women with pre-GDM, 57% had Type 1 diabetes, 20% had Type 2 diabetes and for 23% the type of diabetes was unknown. Major maternal morbidity or mortality was more common in women with pre-GDM (7.9%) [odds ratio (OR) 3.2, 95% confidence interval (CI) 2.6, 3.9] and in women with GDM (3.1%) (OR 1.2, 95% CI 1.1, 1.4) when compared with women without diabetes (2.6%). Major infant morbidity or mortality occurred more frequently in infants exposed to pre-GDM compared with no diabetes (13.6% vs. 3.1%) (OR 5.0, 95% CI 4.2, 5.8) and in infants exposed to GDM compared with no diabetes (3.2% vs. 2.3%) (OR 1.4, 95% CI 1.3, 1.5). Conclusions Pre-GDM and GDM continue to be associated with an increased risk of adverse maternal and neonatal outcomes; however, women with GDM have adverse outcomes less frequently. Rates of GDM and pre-GDM appear to be increasing over time. Clinicians should consider the potential for adverse outcomes, and arrange referral to appropriate services.

Objetivo: el objetivo del presente trabajo es revisar la epidemiología, la clasificación clínica, el diagnóstico y el tratamiento de la diabetes pregestacional y gestacional. Materiales y métodos: con las palabras clave diabetes, diabetes gestacional, diabetes pregestacional, y embarazo se buscó información en la bases de datos de Pubmed/Medline, Cochrane, SciELO, al igual que en las referencias de los artículos de revistas y textos, especialmente de los últimos cinco años. El resultado de esta búsqueda arrojó 79 referencias, de lascualessetomaronlas35másrelevantes,teniendo en cuenta principalmente metaanálisis, artículos de revisión, estados del arte, estudios aleatorizados doble ciego y guías clínicas. Resultados: el buen control de la glicemia en el embarazo evita o disminuye las complicaciones maternas y fetales. En el 0.2-0.3% de todos los embarazos se conoce que la mujer ha tenido diabetes previa a la gestación, y la diabetes gestacional complica el 1-14 % de los embarazos. El criterio de la OMS exige una glicemia > 140 mg/dl a las dos horas de postcarga con 75 g de glucosa oral para hacer el diagnóstico de diabetes gestacional. También se puede hacer el diagnóstico con dos glicemias de ayuno > 105 mg/dl o una glicemia de ayuno > 126 mg/dl o una glicemia en cualquier momento > 200 mg/dl. Conclusión: un mejor control de las cifras de glucemia durante el embarazo está asociado a un mayor bienestar fetal. Objective: the objective of the present work is to review the epidemiology, the clinical classification, the diagnosis and the treatment of the pre gestational and gestational diabetes. Materials and methods: with the key words: diabetes, gestational diabetes, pregestational diabetes,diabetesandpregnancywordsinformation we looked for data bases of Pubmed/Medline, Cochrane, SciELO, like in article references of magazine and texts mainly of last the five years. The result of this search threw 79 references from which they were taken 35 more relevant, vtaking vmainly meta analysis, review articles, state of the art, double-blind, randomized studies and practice guideline. We used the following. Results: good control of glycemia during pregnancy avoids or reduces maternal and foetal complications. It is known that women have suffered diabetes prior to their becoming pregnant in 0.2%-0.3% of all pregnancies and that gestational diabetes complicates 1%-14% of all pregnancies. WHO criteria require > 140 mg/dl glycemia at 2 hours post-test, 75 g oral glucose being necessary for diagnosing gestational diabetes. Diagnosis can also be made from two glycemia readings of > 105 mg/dl on an empty stomach or one > 126 mg/dl glycemia reading on an empty stomach or a > 200 mg/dl glycemia reading regardless of the time of day and time of the last meal. Conclusion: a better control of the numbers of glucosa during the pregnancy is associate to a greater fetal well-being.

Background: The risk of congenital malformations is two to three times higher among women with diabetes mellitus before pregnancy. Gestacional diabetes is emerging as a risk factor for malformations. Aim: To study the rate and type of congenital malformations among offspring of women with pre-gestational or gestational diabetes. Material and methods: A search in the databases of the Collaborative Latin American Study for Congenital Malformations and of the Neonatology Unity of The University of Chile Clinical Hospital. All births from January 1998 through June 2004 were investigated. Results: In the study period, 13,965 births occurred, of which 0.7% were stillbirths and 8.1% had malformations. A total of 295 women (2.1%) had diabetes (gestational diabetes in 1.8% and pre gestational diabetes in 0.3%). The prevalence of congenital malformations was 14% and 18.3% among offspring of mothers with pre-gestational and gestational diabetes, respectively (p=NS). The prevalence of congenital malformations among offspring of non diabetic women was 7.9% (p

Introduction Women with pre-gestational diabetes experience an increased risk of adverse pregnancy outcome, but there are limited data on recurrence of adverse outcome. This study examined recurrence of adverse outcome in a cohort of women with pre-gestational diabetes from Northern England. Methods 221 women with pre-gestational diabetes and with a first and second pregnancy during 1996–2008 were identified from the Northern Diabetes in Pregnancy Survey. Rates of adverse outcome (fetal loss at any gestation, major congenital anomaly, or infant death) for each pregnancy and recurrence rates were determined using descriptive approaches. Predictors of adverse outcome were examined by logistic regression. Results 69 (31%) first pregnancies ended in adverse outcome, including 14 (6%) with congenital anomalies, 52 (24%) additional fetal losses, and 3 (1%) additional infant deaths. 41 (19%) second pregnancies ended in adverse outcome, significantly less than the rate among first pregnancies (p=0.002), including 21 (10%) with congenital anomaly, 19 (9%) additional fetal losses, and 1 ( Conclusion The overall risk of adverse pregnancy outcome is lower in second pregnancies than first, but history of an adverse outcome increases the risk in the second pregnancy.

Aim To compare maternal characteristics and pregnancy outcomes in twin pregnancies to women with and without pre-gestational diabetes. Method We analysed data on 27 women with pre-gestational diabetes (54 twins) and 6407 women (12,814 twins) without diabetes from the Northern Survey of Twin and Multiple Pregnancy (NorSTAMP) during 1998–2010. Descriptive statistics were used to compare maternal characteristics between the groups. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) for combined adverse pregnancy outcome (fetal loss Results Twin mothers with diabetes were older (p = 0.001) with higher BMIs (p Conclusion The presence of maternal pre-gestational diabetes was associated with more than three-fold increased risk of adverse pregnancy outcome in twins conferring a similar risk to that of monochorionicity.

Objective To provide perinatal mortality and congenital anomaly rates for babies born to women with type 1 or type 2 diabetes in England, Wales, and Northern Ireland. Design National population based pregnancy cohort. Setting 231 maternity units in England, Wales, and Northern Ireland. Participants 2359 pregnancies to women with type 1 or type 2 diabetes who delivered between 1 March 2002 and 28 February 2003. Main outcome measures Stillbirth rates; perinatal and neonatal mortality; prevalence of congenital anomalies. Results Of 2359 women with diabetes, 652 had type 2 diabetes and 1707 had type 1 diabetes. Women with type 2 diabetes were more likely to come from a Black, Asian, or other ethnic minority group (type 2, 48.8%; type 1, 9.1%) and from a deprived area (type 2, 46.3% in most deprived fifth; type 1, 22.8%). Perinatal mortality in babies of women with diabetes was 31.8/1000 births. Perinatal mortality was comparable in babies of women with type 1 (31.7/1000 births) and type 2 diabetes (32.3/1000) and was nearly four times higher than that in the general maternity population. 141 major congenital anomalies were confirmed in 109 offspring. The prevalence of major congenital anomaly was 46/1000 births in women with diabetes (48/1000 births for type 1 diabetes; 43/1000 for type 2 diabetes), more than double that expected. This increase was driven by anomalies of the nervous system, notably neural tube defects (4.2-fold), and congenital heart disease (3.4-fold). Anomalies in 71/109 (65%) offspring were diagnosed antenatally. Congenital heart disease was diagnosed antenatally in 23/42 (54.8%) offspring; anomalies other than congenital heart disease were diagnosed antenatally in 48/67 (71.6%) offspring. Conclusion Perinatal mortality and prevalence of congenital anomalies are high in the babies of women with type 1 or type 2 diabetes. The rates do not seem to differ between the two types of diabetes.

Background Pre-gestational diabetes is associated with a range of adverse pregnancy outcomes, including an increased risk of major congenital anomalies. The impact on normally-formed offspring, however, is less well defined. This study utilised data from a long-running population-based survey of women with pre-gestational diabetes to explore the risks of foetal and infant death and examine which factors modify these risks. Methods All normally-formed singleton pregnancies delivered at ≥20 weeks of gestation in the North of England during 1996-2008 were identified from the population-based Northern Perinatal Morbidity and Mortality Survey. Pregnancies affected by pre-gestational diabetes were identified from the Northern Diabetes in Pregnancy Survey, which also collects data on a range of clinical and sociodemographic variables. Relative risks (RRs) of foetal death (≥20 weeks gestation) and infant death were estimated by comparing the prevalence among women with and without pre-gestational diabetes. Predictors of foetal and infant death in women with pre-gestational diabetes were examined by logistic regression. Glycated haemoglobin concentrations (HbA1c) within three months peri-conception and in the third trimester (as markers of blood glucose concentration) were analysed by piecewise regression due to curvilinear associations. Results There were 46 foetal deaths and 10 infant deaths among 1548 deliveries in women with pre-gestational diabetes. The prevalence of foetal death in women with diabetes was over four times greater than among those without (RR 4.54 [3.41, 6.05], p Conclusion Pre-gestational diabetes is associated with a substantially increased risk of fetal death in normally-formed offspring, the effect of which appears to be largely moderated by glycaemia control. Greater vigilance in the control of blood glucose, both before and throughout pregnancy, is needed if the risks of serious adverse pregnancy outcomes in women with pre-gestational diabetes are to be reduced towards the levels in healthy women.

Background: Gestational Diabetes mellitus (GDM) has emerged as an important public health problem affecting mothers and their offspring in later life. The role of diet is highly important as adequate and good nutrition is needed to the mother and foetus. Aims & Objective: It is imperative to study the nutritional adequacy of these patients and the objective of the study is to identify women with gestational glycaemia and assess their nutritional adequacy in gestation. Material and Methods: Pregnant women (n=504) reporting to a Diabetes Referral centre at Chennai were selected by purposive sampling and screened for glucose intolerance at the first visit. The socio-demographic details, anthropometry and bio-chemical assessment was done. About 240 women in the 25-30 age groups, primi and in the first trimester were selected to study the nutritional adequacy in the antenatal period using a food frequency questionnaire and 24-hour recall method. The mean nutrient intake was calculated and compared with the RDA of pregnant women (ICMR). Results: The findings revealed that the diet of the GDM women was not balanced in terms of quantity of nutrients and exhibited poor quality. The nutrient intake did not meet the RDA requirements; the consumption of CHO was excess and inconsistent in meals. Conclusion: The glaring fact was the consumption of energy-dense diet, high in saturated fat, low in unrefined CHO, dietary fibre and deficit iron intake contributed to nutritional inadequacy in the GDM women.

Background Large fetal size (macrosomia) is a frequent pregnancy complication in women with diabetes. High blood glucose during pregnancy is hypothesised to explain much of the association, but previous investigations have presented equivocal results. This could be due to inadequate adjustment for confounding factors or a non-uniform association between blood glucose concentration and birth weight. This study investigated the association between blood glucose concentrations during early and late pregnancy and birth weight in women with pre-gestational diabetes, whilst accounting for a range of potentially relevant clinical and socio-demographic factors. Methods All singleton births in women with pre-gestational diabetes delivered during 1996–2008 were identified from the Northern Diabetes in Pregnancy, a population-based survey of all pregnancies occurring in women with pre-gestational diabetes in the North of England. Cases of congenital anomaly (identified from the Northern Congenital Abnormality Survey) were excluded. Three measures of glycated haemoglobin concentration (HbA1c) were obtained, to estimate the blood glucose concentration around conception, and during the second and third trimesters. The associations between HbA1c at these time points, a range of other clinical and socio-demographic variables, and birth weight were examined by multiple linear regression. The total and indirect associations were further examined by path-analysis. Gestational age was modelled as a three-order polynomial. Results Increasing peri-conceptional HbA1c was associated with reduction in birth weight (adjusted regression coefficient, b=-50.4 grams per 1%, 95% CI: -71.1 to -29.6), while increasing third-trimester HbA1c was associated with increase in birth weight (b=171.9 grams per 1%, 95% CI: 132.1–211.7). There was no association between birth weight and second-trimester HbA1c. Of the other variables in the adjusted model; male sex, increasing maternal height, increasing maternal BMI, multiparity, and later gestational age at delivery were all significantly associated with larger birth weight, while increasing maternal age, later gestational age at booking, maternal smoking, history of pre-pregnancy nephropathy or retinopathy were all significantly associated with smaller birth weight. Maternal socio-economic status (estimated from maternal postcode at birth) was associated with a range of birth weight modifiers (maternal height, BMI, age, parity, smoking status, and periconceptional HbA1c), but as these acted in opposite directions, the overall effect on birth weight was negligible. Conclusion Maternal blood glucose concentrations are associated with birth weight, but the association is complex, reversing as pregnancy progresses. For women with pre-gestational diabetes, maintaining good glucose control throughout pregnancy is likely to be associated with the lowest risk of pathological fetal size.

Objective To investigate maternal, perinatal, and neonatal outcomes of pregnancies in women with type 1 diabetes in the Netherlands. Design Nationwide prospective cohort study. Setting All 118 hospitals in the Netherlands. Participants 323 women with type 1 diabetes who became pregnant between 1 April 1999 and 1 April 2000. Main outcome measures Maternal, perinatal, and neonatal outcomes of pregnancy. Results 84% (n = 271) of the pregnancies were planned. Glycaemic control early in pregnancy was good in most women (HbA 1c  7.0% in 75% (n = 212) of the population), and folic acid supplementation was adequate in 70% (n = 226). 314 pregnancies that went beyond 24 weeks9 gestation resulted in 324 infants. The rates of pre-eclampsia (40; 12.7%), preterm delivery (101; 32.2%), caesarean section (139; 44.3%), maternal mortality (2; 0.6%), congenital malformations (29; 8.8%), perinatal mortality (9; 2.8%), and macrosomia (146; 45.1%) were considerably higher than in the general population. Neonatal morbidity (one or more complications) was extremely high (260; 80.2%). The incidence of major congenital malformations was significantly lower in planned pregnancies than in unplanned pregnancies (4.2% (n = 11) v 12.2% (n = 6); relative risk 0.34, 95% confidence interval 0.13 to 0.88). Conclusion Despite a high frequency of planned pregnancies, resulting in overall good glycaemic control (early) in pregnancy and a high rate of adequate use of folic acid, maternal and perinatal complications were still increased in women with type 1 diabetes. Neonatal morbidity, especially hypoglycaemia, was also extremely high. Near optimal maternal glycaemic control (HbA 1c  7.0%) apparently is not good enough.