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EDITORIALS: Alison Macfarlane and Derek Tuffnell Diabetes and pregnancy BMJ 2006; 333: 157-158 [Full text]

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Improving Outcomes in Diabetic Pregnancies

Katharine M Morrison   (25 July 2006)

Diabetes, pregnancy and consanguinity

Michael I Carter   (25 July 2006)

Improving Outcomes in Diabetic Pregnancies 25 July 2006
Katharine M Morrison, General Practitioner Ballochmyle Medical Group Mauchline KA5 6AJ Send response to journal: Re: Improving Outcomes in Diabetic Pregnancies	Why are women in the UK not given the option of going on a low carbohydrate diet to improve the outcome of their pregnancies? Low carbohydrate diets give a dramatic improvement in maternal and foetal outcomes. Less insulin is used, there is less macrosomia and less caesarian sections with this approach.[1] "Pumping Insulin" a leading textbook for insulin pumpers and their physicians advocate a low carb diet for all women contemplating a pregnancy starting at 40% carb 40% fat and 20% protein. ( John Walsh and Ruth Roberts chapter 18)[2] Amounts of carbohydrate can then be adjusted downwards till normoglycaemia is acheived. This highly effective method is advocated by Dr Lois Jovanovich, a type one diabetic herself, who is Clinical Director for the Sansum Clinic in Santa Barbara USA. ( Lets police the glucose and not be ketone cops: Dietary recommendations for gestational diabetes indicate that lower carbohydrate is better. www.endocrinetoday.com/200512/glucose.asp) At least a good part of the solution to this problem can be achieved right now by correct dietary advice. How long is it going to take for this to get through to the families that need this information the most? 1 CA Major, MJ Henry, M De Veciana and MA Morgan, The effects of carbohydrate restriction in patients with diet controlled gestational diabetes. Obstetrics and Gynaecology 1998; 91: 600-604. 2 John Walsh and Ruth Roberts, Pumping Insulin. Torrey Pines Press 3rd Edition ISBN 1884804845 Competing interests: None declared
Diabetes, pregnancy and consanguinity 25 July 2006
Michael I Carter, Consultant Anaesthetist Luton & Dunstable Hospital NHS Trust, Lewsey Road. Luton Beds. LU4 0DZ Send response to journal: Re: Diabetes, pregnancy and consanguinity	Dear Editor, The editorial on “Diabetes and pregnancy” (BMJ 333, 22nd July 2006, pp157-158) mentioned particular problems with the Pakistani community in Bradford and their access to care. It did not mention the issue of consanguinity, which may increase the likelihood of diabetes, congenital abnormalities or both. Having worked in Watford and Luton with Pakistani communities from different parts of that country, the issue of consanguinity appeared less important in Watford than it is in Luton. In my pre-operative assessments here, I enquire of patients their ethnic background, and if they are from Pakistan, I will enquire of the paediatric, adult or obstetric patients whether there are first cousin marriages in the family, and if positively answered, whether that goes back a generation or more. Bradford and Luton have both been involved in Pursuing Perfection programmes, and our Obstetric and Midwifery colleagues here have sought to lower the stillbirth rate and improve overall care for the Pakistani community in three particular electoral wards where their communities are in a majority, and where the stillbirth postcodes indicate there is a particular problem. The community midwives specialise in their care and have access to interpreters and other interventions to promote the maternal and neonatal well-being. Yours sincerely Dr Michael Carter MA MB BChir DA FRCA Consultant Anaesthetist with paediatric and obstetric interest Luton & Dunstable Hospital NHS Trust Lewsey Road Luton Beds.LU4 0DZ Competing interests: None declared