Foreword

The improvements in the management of the woman who has diabetes mellitus or who develops diabetes mellitus during pregnancy (gestational diabetes), especially over the last decade, has meant that in the t990s she can reasonably expect to produce a healthy infant without significant risk to herself.

Before insulin became available in 1922, maternal mortality was 45% and perinatal mortality 60%. The dramatic improvements that followed insulin therapy have been due to such factors as the realization of the importance of achieving euglycaemia, especially in the early weeks of pregnancy, the avoidance of premature delivery, the development of neonatal intensive care, and to the team approach to the management of women with diabetes in pregnancy.

Many controversies still abound in this field and this is particularly so in gestational diabetes. There is no international, or often even regional, consensus on the criteria to be used for the diagnosis of gestational diabetes, although at last there are initiatives being taken to remedy this. As perinatal mortality rates approach those of pregnancies with normal glucose tolerance, the prevention of macrosomia has become the principal objective of management. The long-term implications of macrosomia are intriguing and may turn out to be one of the main justifications for the considerable amount of effort and money being expended on screening programmes for gestational diabetes, and for the desirability of meticulous glycaemic control in both pre-gestational and gestational diabetes.

The object of this book is not to provide a comprehensive review of all aspects of diabetes in pregnancy, as space is limited and a number of excellent and very detailed books have been published recently on the subject. Rather, it is to bring to the attention of practitioners, who may not be deeply involved in this sub-specialty, particular aspects of this important complication of pregnancy.

We have been fortunate to have contributions from an international group of experts in this field, from North America, Europe and the Antipodes. I am particularly grateful to the contributors for their willing participation in the preparation of this book. They all have heavy clinical, research and teaching loads and their writing is at the expense of their all too

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X FOREWORD

rare leisure time. I would also like to express my gratitude to the editorial staff at Bailli~re Tindall whose patience has been stretched to the limit.

J E R E M Y N. OATS