The organization and management of pregnancies in women with hyperglycemia vary significantly across countries, often shaped by economic resources and national priorities. This variability complicates the distinction between obstetric advancements and those attributed to medication, dietary interventions, or technological innovations. Additionally, the balance between preventing serious adverse outcomes in a minority of cases and introducing potential harm to the majority is a persistent challenge in obstetric management, where there is a zero-tolerance approach to making "the wrong decision."
Research in obstetrics is predominantly grounded in observational studies, with relatively few randomized trials. This is due to various factors, including the necessity for large-scale studies to demonstrate improvements in rare but serious outcomes, as well as the ethical concerns around intervening in situations with risks like stillbirth. Consequently, obstetric management is frequently guided by safe choices, consensus, and tradition rather than high-level empirical evidence.
This presentation will begin with a historical overview of the advances in managing pregnancies complicated by hyperglycemia, providing context through the lens of the St. Vincent Declaration of 1989. Following this, the discussion will focus on the use of observational studies to inform obstetric practices, particularly from a Danish perspective, in the management of women with preexisting diabetes. Key obstetric challenges, such as falling insulin requirements, routine cardiotocography monitoring, and decisions regarding the mode and timing of delivery, will be addressed. Finally, the talk will propose clinical and research priorities that could further enhance the obstetric management of women with hyperglycemia during pregnancy in the future.