A team of experts from the fields of gynaecology and obstetrics, diabetology, internal medicine, paediatrics and midwifery from Germany, Austria and Switzerland produced a new version of the existing S3 guideline on gestational diabetes. It replaces the recommendations of the German Association for Gynaecology and Obstetrics and the German Diabetes Association on the diagnosis and treatment of gestational diabetes from 2011 and is valid for the three German-speaking countries. The primary aim of the guideline is to improve and standardise the prevention, screening, diagnosis, treatment and follow-up of gestational diabetes through evidence-based recommendations for the outpatient and inpatient area. A large number of new studies and data published in the last few years required a comprehensive revision of the 2011 guideline. The new aspects include early screening of pregnant women with a high risk for diabetes or gestational diabetes, the validity of two-stage screening in the third trimester by means of the 50-g challenge test, as specified in the maternity guidelines, use of metformin instead of or in addition to insulin in gestational diabetes, and birth planning with GDM and/or macrosomia. The recommendations are based on the evidence from the literature, which was selected through a systematic external literature search. All recommendations had to pass through a consensus process. The present text corresponds to the practice guideline on gestational diabetes, which is an action-oriented short version of the evidence-based S3 guideline that can be viewed on the internet.

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This practice guideline on gestational diabetes is a treatment oriented short version of the evidence based guideline that can be viewed in the internet. It replaces the DDG and DGGG recommendations of 2001 for diagnostic and therapy of gestational diabetes. A complete rework had become necessary in view of epidemiologically based diagnostic criteria, which had been derived from the Hyperglycaemia and Adverse Pregnancy Outcome study (HAPO) by international consensus, and in view of randomised therapy and observation studies published after 2001. With this, Germany has adopted the international standard. Screening and diagnosing gestational diabetes by means of blood glucose are part of the legally binding maternity guidelines in Germany since March 3, 2012. Definition ! Gestational diabetes mellitus (GDM, ICD-10: 024.4G) is defined as a glucose tolerance disorder which is first diagnosed in pregnancy with a 75 g oral glucose tolerance test (OGTT) under standardised conditions with a quality controlled measurement of venous plasma glucose. Diagnosis is possible with a single elevated glucose level. One the other hand, the definition of manifest diabetes during pregnancy is based on criteria that applies outside of pregnancy; that is, manifest diabetes during pregnancy is not classified as GDM. Pathophysiology, Health Objectives ! GDM is usually described as a functional disorder marked by increasing insulin resistance with declining beta cell compensation. Its pathophysiology is similar to that of type 2 diabetes to a large extent. The frequency of poor pregnancy outcomes in women with GDM can be reduced by timely diagnosis and appropriate treatment. Epidemiology ! According to the perinatal statistics, GDM prevalence in Germany rose from 3.7 % in 2010 to 4.3 % in 2012 (roughly 28 200 cases in 2012). Consequences ! Acute Consequences for the Mother There are increased risks for ▶ urinary tract and vaginal infections with resultant increased premature birth rates, ▶ gingivitis, ▶ preeclampsia, ▶ inductions of labour, ▶ fetal macrosomias, ▶ cesarean sections, ▶ shoulder dystocias, ▶ perineal tears, and ▶ post partum bleeding requiring a blood transfusion. Long-Term Consequences for the Mother Diabetes Risk in Later Life The number of women with GDM who develop diabetes within 10 years after the pregnancy is 35-60 % compared to women without GDM. This constitutes a 7 to 10-fold increase of risk. In the first year after the pregnancy, some 20 % of these women develop various forms of abnormal glucose metabolism. The risk is increased with preconceptional obesity, a GDM diagnosis before

Several groups have reported a risk of fetal macrosomia in pregnancies with maternal glucose intolerance which is intermediate between gestational diabetes (GDM) and normal glucose tolerance. The present study was designed to determine whether these pregnancies are also at risk for fetal obesity, hyperinsulinism and placental villous immaturity. 325 women with risk factors for GDM underwent a 75 g OGTT interpreted according to the O'Sullivan criteria. All women who met the criteria for GDM were managed with diet therapy. Insulin therapy was added for women with a mean serum glucose value > 100 mg/dl on a 24 hour glucose profile. Patients not meeting the GDM criteria were managed without special intervention. Primary outcome variables were measures of neonatal weight and skinfold thickness, fetal and neonatal insulin and glucose concentration, and placental villous maturation. Outcome parameters were compared among three groups: pregnancies with normal OGTT (control, n = 95), 1 abnormal value in the OGTT (1 abnl, n = 76) and GDM (n = 154). The outcome of pregnancies with 1 abnormal value in the OGTT was different from those with normal OGTT. Regarding fetal growth, rates of LGA were approximately twice as high in groups with one abnormal value and GDM (21% and 24%) compared to women with normal OGTTs (11%: p < 0.05 vs GDM and p = 0.07 vs 1 abnormal value). The percent of infants with skinfold thickness > 90th percentile was also greater in the 1 abnormal value and GDM groups (31.1 and 31.6% respectively) compared to controls (19.2%; p < 0.05 for GDM vs control only). Regarding fetal hyperinsulinism, AFI concentrations were similar in control and GDM groups (3.1 +/- 0.4 and 3.4 +/- 0.8 microU/ml, respectively), but were higher in the group with one abnormal OGTT value (4.3 +/- 1.2 microU/ml, p < 0.05 vs controls). Cord blood insulin: glucose ratios were elevated in both the 1 abnormal value and GDM groups (0.22 +/- 0.05 and 0.20 +/- 0.02 microU/ml per mg/dl), compared to controls (0.12 +/- 0.01 microU/ml per mg/dl, p < 0.05 vs 1 abnormal value). Neonatal glycemia < 30 mg/dl was significantly more common in the one abnormal value than in the control group (49% vs 34% of infants) and intermediate in the GDM group (40%). Severe placental villous immaturity was more than twice as frequent in the 1 abnormal value group compared to controls (24% vs 9%, p < 0.05) and the most frequent in the GDM group (33%; p < 0.001 vs controls). Pregnancies with glucose intolerance below the thresholds for diagnosis of GDM have an increased risk for fetal obesity, hyperinsulinism, postpartum hypoglycemia and placental immaturity. These findings indicate the continuum of risk for fetal morbidity associated with increasing maternal glucose intolerance in pregnancy.

Aim As diagnostic and therapeutic options have improved in recent years, women with limited renal function of varying etiologies are now able to become pregnant. Depending on the extent of disease and the patientsʼ comorbidities, the care of these women can be especially challenging. This guideline aims to improve the interdisciplinary care offered to pregnant women with kidney disease. Methods A selective literature search was carried out. This S2k guideline was then compiled using a structured consensus-based process which included representatives from different medical specialties and professional societies. Recommendations Recommendations for the care of pregnant women with renal disease were developed to cover preconception counseling, the recording of risks, special aspects of prenatal care and prenatal screening, as well as the specific treatment options for the underlying disease in women wanting to have children and pregnant women.

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Myasthenia gravis is an autoimmune disease with a range of clinical presentations which manifest as combinations of weakness of the ocular, bulbar, and respiratory muscle groups and muscles of the extremities. Young women of reproductive age are most commonly affected. Preconception planning, the impact of pregnancy, prepartum management, drug therapy in pregnancy, myasthenic and cholinergic crises, fetal monitoring, peripartum management including analgesia and anesthesia during labor and cesarean section as well as neonatal management and neonatal myasthenia gravis are described here and the appropriate recommendations are given.

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