DIABETICMedicine DOI: 10.1111/dme.12281
Editor’s Selection: This Month’s Highlighted Articles
Pregnancy and diabetes Diabet. Med. 30, 1013 (2013) In this month’s issue of Diabetic Medicine, we have published a number of articles related to diabetes and pregnancy; these form the editor’s selection this month. Although there are excess risks associated with diabetes in pregnancy to both the mother and child, there is good evidence that they may be ameliorated pre-conception and during pregnancy. National audits of clinical care are frequently drivers for improved clinical care and improved outcomes. We therefore welcome the initiative from the UK National Pregnancy in Diabetes (NPID) audit described in the commentary (page 1014) that is hoped will drive improvements in pregnancy outcomes. Recognizing the complexity of collecting data nationally, the audit consists of 20 data items related to three key areas: 1. Were women with diabetes adequately prepared for pregnancy? 2. Were appropriate steps taken during pregnancy to minimize adverse outcomes? 3. Were adverse outcomes minimized during pregnancy? The challenge now is to collect and share the data from all organizations providing pregnancy care for diabetes and to learn from each other and make real changes of benefit to people with diabetes and their offspring. The focus in the treatment of diabetes in pregnancy is on tight glycaemic control. Three articles published this month put additional emphasis on management of weight gain, hypovitaminosis D and hypertension. In a retrospective audit of gestational diabetes in 1695 women, Barnes and colleagues report (page 1040) that 7.9% of the offspring were found to be small for gestational age and 15.2% large for gestational age. Significant predictors for large gestational age included pre-pregnancy BMI, weight gain in pregnancy and treatment type, but not HbA1c or smoking. Significant predictors of small for gestational age were weight gain during pregnancy, but again not HbA1c or smoking. Although the issue of reverse causality needs to be addressed, it highlights the importance of weight management in pregnancy. Low vitamin D status is an established risk factor for hyperglycameia, although replenishment strategies have yet to be shown to prevent diabetes. In a study by Tomedi and colleagues (page 1033) in 429 pregnant women, the authors find an association of vitamin D status with maternal hyperglycaemia, but only in smokers. Clearly, for a host of
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Cover image: This issue of Diabetic Medicine focuses on diabetes and pregnancy and the importance to both mother and child. Credit: Sciepro/Science Photo Library
reasons, we should be encouraging pregnant women not to smoke or be exposed to passive inhalation from other family members. However, the relation of vitamin D status, hyperglycaemia, smoking and other confounders demands further study, especially in pregnancy. In the third paper, Klemetti and colleagues (page 1087) draw attention that hypertension is increasing in pregnant women with Type 1 diabetes, although as yet this is not accompanied by an increase in hypertensive complications. Breastfeeding has many positive benefits for both women and children, but, nonetheless, there is evidence that there are lower rates of breastfeeding in women with Type 1 diabetes, Type 2 diabetes and gestational diabetes. In the last of the set of pregnancy articles, Finkelstein and colleagues (page 1094) draw attention to low rates of breastfeeding in hospital, especially in women with insulin-treated diabetes in pregnancy, but also gestational and non-insulin-treated diabetes; furthermore, gestational diabetes was additionally associated with low rates of breastfeeding on discharge. G. A. Hitman Editor-in-Chief Diabetic Medicine
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