Professor of Medicine and Obstetrics and Gynecology and Director of the University of Southern California Center for Diabetes and Metabolic Diseases, The Keck School of Medicine of the University of Southern California, Los Angeles, California
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During the past two decades, as the culmination of many years of basic and clinical research in different fields of maternal–fetal–neonatal medicine, there has been a dramatic improvement in perinatal mortality and morbidity in diabetes pregnancy. Today, the chances for most women with diabetes mellitus to have a successful pregnancy are almost as good as those of a woman without diabetes mellitus, providing the health care professional and the patient adhere to the guidelines and recommendations accepted by most workers in this area. In this brief historical review, several stages in the diagnosis and management of diabetes and pregnancy are discussed, based on hallmark articles from the medical literature. After a review of the years before the discovery of insulin, the author describes each decade from 1922 until the end of 1970s [Fig. 1), in which, in his opinion, the most remarkable gains in the care of pregnant women with diabetes and neonatal health had occurred. During the past twenty years, numerous reports in the literature have reaffirmed the success of strict metabolic control, before and during pregnancy, and the proper use and interpretation of fetal well-being tests in the improvement of fetal outcome. The mechanisms of the cause of congenital malformations, the multiple factors affecting fetal growth and development, and its potential long-term effects on the offspring of diabetic mothers are the focus at the present time of intensive investigation.