ABSTRACT
Before the discovery of insulin and its appropriate implementation, pregnancy complicated by diabetes was associated with significant maternal and fetal morbidity and mortality. With improvements in care, the fetal and neonatal mortality has dropped from 60% in the preinsulin era to 2-4% (1). Diabetes is present in 4% of all pregnancies in the United States. Gestational diabetes accounts for approximately 88%, or 135,000 of such pregnancies, whereas progestational diabetes, both type 1 and 2, account for the remainder (2). Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with its onset occurring during pregnancy (3). Progestational diabetes mellitus encompasses both type 1 diabetes mellitus, a state of absolute insulin deficiency most frequently immune-mediated, and type 2 diabetes mellitus, a state of relative insulin deficiency, often associated with insulin resistance and secretory defects. Because poor glycemic control at conception and during the period of organogenesis is associated with an increased risk of spontaneous abortion and a high incidence of major congenital anomalies, it is imperative that the woman with preexisting diabetes plan her pregnancy achieving satisfactory metabolic control before conception.
