ABSTRACT
Type I diabetes mellitus, also known as insulin-dependent diabetes mellitus (IDDM), complicates less than 0.5% of pregnancies. Type II diabetes mellitus, or non-insulin dependent diabetes mellitus (NIDDM), is less common in the age group likely to become pregnant. Poor fetal outcome may be slightly more likely in non-specialist settings – one study showed a 4.5% rate of fetal and neonatal death in the absence of specialist regional guidelines. Good metabolic control is the cornerstone of management of the pregnant diabetic. Pregnancies should be planned and pre-conception counselling offered. Expert dietary advice from a dietician is essential. Snacks should be eaten between meals and at bedtime to reduce the incidence of ketogenesis. Regular home blood glucose monitoring is necessary if good diabetic control is to be achieved. Insulin does not cross the placenta but metabolic disturbances due to excess or lack of insulin will affect the fetus. Hypoglycaemic attacks are more common during pregnancy.
