The prevalence of pre-existing diabetes mellitus in pregnancy (DIP) is about 1% and gestational diabetes (GDM) at 8-30% of pregnancies in Australia. 1,2 DIP and to a lesser extent, GDM are well-known risk factors implicated in a variety of maternal and obstetric complications, including stillbirth and neonatal deaths. The management of diabetes before and during pregnancy is critical in minimising the risk of such complications. The risks of a diabetic pregnancy to a fetus are numerous and include stillbirth, intra-uterine growth restriction (IUGR), large for gestational age (LGA) and macrosomia with associated traumatic birth injuries, congenital abnormalities, intrapartum hypoxia-ischaemia, electrolyte and metabolic abnormalities, and

Background: Knowledge about expected insulin requirements during pregnancy, in women with pre-existing diabetes may assist clinicians to effectively respond to gestation-specific changes in glycemic pattern. Few studies have examined differences between type 1 (T1DM) and type 2 diabetes (T2DM). Aims: To compare patterns of insulin requirements in pregnancy for women with pre-existing T1DM and T2DM. Women with T1DM had a net fall in insulin requirements (3.7% in the first trimester and 4.1% in the late third trimester) while those with T2DM did not. Conclusions: This is the largest comparison study of insulin requirements in women with pre-existing diabetes, highlighting important trimester-specific differences between T1DM and T2DM to guide insulin titration during pregnancy. Our findings suggest a differential effect of pregnancy-mediated insulin resistance by type of diabetes.

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