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10 Years Later… Diabetes Mellitus and Pregnancy

Wollitzer, Adrienne D. BA*; Jovanovic, Lois MD†

doi: 10.1097/01.ten.0000255881.94515.28
CME Review Article #2
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The past 10 years have seen an incredible increase in the number of people with type 2 diabetes mellitus. Pregnancy is no exception, and the alarming rates of diabetes in pregnancy continue to rise. However, the last decade has also seen extraordinary gains, as both our understanding and treatment of this disease have improved dramatically. Although advances have been made in all aspects of diabetes and pregnancy, this article will focus on gestational diabetes (GDM), which currently affects up to 14% of all pregnancies. Research has continued to show that maintaining euglycemia during pregnancy reduces and can even eliminate the risk for GDM complications, such as fetal macrosomia, stillbirth, and congenital malformations. Additionally, normalizing glycemic levels during pregnancy can reduce the risk of offspring of diabetic mothers (ODM) becoming obese and having type 2 diabetes early in life. Although disputed by some, the most compelling data shows maintaining glucose levels that mimic nondiabetic pregnancies results in fewer maternal complications and improves fetal outcome. With the acceptance of postprandial blood glucose levels as the standard indicator for GDM risk, broader prenatal screening, and the use of insulin analogues in pregnancy, glucose control is improving and more women with gestational diabetes are having healthy babies.

*Summer Intern and †CEO and Chief Scientific Officer, Sansum Diabetes Research Institute, Santa Barbara, California.

Adrienne Wollitzer has disclosed that she has no significant relationships with or financial interests in any commercial company that pertains to this educational activity.

Dr. Jovanovic has disclosed that she was/is the recipient of grant/research support from Eli Lilly and Novo-Nordisk. Dr. Jovanovic also was/is a consultant/advisor and on the speakers bureau for Eli Lilly and Novo-Nordisk.

The authors have disclosed that the use of insulin analogues has not been approved by the U.S. Food and Drug Administration for use in the treatment of pregnancy. Please consult product labeling for the approved usage of this drug of device.

Lippincott Continuing Medical Education Institute, Inc. has identified and resolved all faculty conflicts of interest regarding this educational activity.

Reprints: Adrienne D. Wollitzer, BA, 1540 Ada Street, Berkeley, CA 94703. Sansum Diabetes Research Institute, 2219 Bath Street, Santa Barbara, CA 93105. E-mail: ljovanovic@sansum.org.

Chief Editor’s Note: This article is the 2nd of 36 that will be published in 2007 for which a total of up to 36 AMA PRA Category 1 Credits™ can be earned. Instructions for how credits can be earned precede the CME Examination at the back of this issue.

© 2007 Lippincott Williams & Wilkins, Inc.