The challenges and future considerations regarding pregnancy-related outcomes in women with pre-existing diabetes

Abstract

Ineffective management of blood glucose levels during preconception and pregnancy has been associated with severe maternal and fetal complications in women with pre-existing diabetes. Studies have demonstrated that preconception counseling and pre-pregnancy care can dramatically reduce these risks. However, pregnancy-related outcomes in women with diabetes continue to be less than ideal. This review highlights and discusses a variety of patient, provider, and organizational factors that can contribute to these suboptimal outcomes. Based on the findings of studies reviewed and authors' clinical and research experiences, recommendations have been proposed focusing on various aspects of care provided, including improved accessibility to effective preconception and pregnancy-related care and better organized clinic consultations that are sensitive to women's diabetes and pregnancy needs.

Conflict of interest statement

Conflict of Interest: Harsimran Singh declares that he has no conflict of interest.

Helen R. Murphy serves on the Medtronic European Advisory Board.

Christel Hendrieckx declares that she has no conflict of interest.

Lee Ritterband declares that she has no conflict of interest.

Jane Speight serves on the Accu-Chek Advisory Board Roche Diagnostics Australia and also Sanofi Aventis, Roche Diagnostics Australia (both relating to diabetes management but not specifically to pregnancy issues). She has received grant support from Sanofi Aventis (relating to diabetes management but not specifically to pregnancy issues). She has also received payment for development of educational presentations including service on speakers' bureaus from Sanofi Diabetes, Abbott Diabetes Care, Roche Diagnostics (relating to diabetes management but not specifically to pregnancy issues). And she received travel expenses provided to support her attendance at a DAWN-2 Study meeting from Novo Nordisk (relating to diabetes management but not specifically to pregnancy issues).