All women with pre-existing type 1 or type 2 diabetes should receive preconception care to optimize glycemic control, assess for complications, review medications and begin folic acid supplementation.• All pregnant women without known pre-existing diabetes should be screened for gestational diabetes between 24 to 28 weeks of pregnancy • If you were diagnosed with gestational diabetes during your pregnancy, it is important to:• Breastfeed immediately after birth and for a minimum of 4 months in order to prevent hypoglycemia in your newborn, obesity in childhood, and diabetes for both you and your childConflict of interest statements can be found on page S274.Can J Diabetes 42 (2018) S255-S282

All women with pre-existing type 1 or type 2 diabetes should receive preconception care to optimize glycemic control, assess complications, review medications and begin folate supplementation. Care by an interdisciplinary diabetes healthcare team composed of diabetes nurse educators, dietitians, obstetricians and diabetologists, both prior to conception and during pregnancy, has been shown to minimize maternal and fetal risks in women with pre-existing type 1 or type 2 diabetes. Gestational Diabetes MellitusThe diagnostic criteria for gestational diabetes mellitus (GDM) remain controversial; however, the committee has chosen a preferred approach and an alternate approach. The preferred approach is to begin with a 50 g glucose challenge test and, if appropriate, proceed with a 75 g oral glucose tolerance test, making the diagnosis of GDM if !1 value is abnormal (fasting !5.3 mmol/L, 1 hour !10.6 mmol/L, 2 hours !9.0 mmol/L). The alternate approach is a 1-step approach of a 75 g oral glucose tolerance test, making the diagnosis of GDM if !1 value is abnormal (fasting !5.1 mmol/L, 1 hour !10.0 mmol/L, 2 hours !8.5 mmol/L). Untreated GDM leads to increased maternal and perinatal morbidity, while treatment is associated with outcomes similar to control populations. Preconception carePreconception care for women with pregestational diabetes is associated with better outcomes (10,11). Although multidisciplinary clinics improve outcomes, <50% of women receive such care. Women who are heavier, younger and smokers, and who have a lower socioeconomic status, lower health literacy and a poor relationship with their healthcare provider, are less likely to receive preconception care (11e14). Some, but not all, have shown that women with type 2 diabetes are also less likely to receive preconception care (7,15). Higher glycated hemoglobin (A1C) levels are associated with poorer outcomes, but even women who achieve tight glycemic control (A1C <7.0%) have an increased risk of complications, which may be caused, in part, by maternal obesity (16,17). By discussing pregnancy prior to conception, healthcare providers may be able to improve outcomes by educating women Contents lists available at SciVerse ScienceDirect Canadian Journal of Diabetes j o u r n a l h o m e p a g e : w w w . c a n a d ia n j o u r n a l o f d i a b e t e s . c o m

Notwithstanding differences in assays, maternal and cord RBC folate and plasma UMFA concentrations were higher than previously reported values. Functional ramifications of high folate and UMFA concentrations in maternal and fetal circulation warrant additional investigation because an excess folate status may affect long-term health outcomes of the offspring. This study was registered at www.clinicaltrials.gov as NCT02244684.

An intrauterine umbilical coiling index can be determined by ultrasound and correlates well with the actual index at birth. The sonographic umbilical coiling index is related to Doppler flow characteristics in the umbilical vein.

No abstract

BACKGROUND: Among singleton pregnancies, gestational diabetes mellitus is associated with adverse outcomes. In twin pregnancies, this association may be attenuated, given the higher rate of prematurity and the a priori increased risk of some of these complications. OBJECTIVE: Our aim was to test the hypothesis that gestational diabetes mellitus is less likely to be associated with adverse pregnancy outcomes in twin compared with singleton gestations. METHODS: This retrospective cohort study comprised all twin and singleton live births in Ontario, Canada, 2012e2016. Pregnancy outcomes were compared between women with vs without gestational diabetes mellitus, analyzed separately for twin and singleton births. Adjusted risk ratios and 95% confidence intervals were generated using modified Poisson regression, adjusting for maternal age, nulliparity, smoking, race, body mass index, preexisting hypertension, and assisted reproductive technology. RESULTS: A total of 270,843 women with singleton (n ¼ 266,942) and twin (n ¼ 3901) pregnancies met the inclusion criteria. In both the twin and singleton groups, gestational diabetes mellitus was associated with (adjusted risk ratio, [95% confidence interval]) cesarean delivery (1.11 [1.02e1.21] and 1.20 [1.17e1.23], respectively) and preterm birth at <37 0/7 weeks

No abstract

No abstract