Diabetes pregnancy has long been associated with a high risk of fetal malformations, spontaneous abortions, stillbirths, macrosomia and neonatal mortality and morbidity1'2. It was not until the introduction of glycated haemoglobin assays in the late 1970s that it became clear that the increased risk of major congenital abnormality in diabetic women was to a large extent determined by poor glycaemic control in early pregnancy3. Since then, several studies have demonstrated that near-normal glycaemia in early pregnancy reduces the frequency of spontaneous abortions and congenital abnormalities to a level close to that of infants of non-diabetic women4-6. This finding is heartening for women with established diabetes who wish to become pregnant, and underscores the need for education and pre-preg-nancy counselling.

Throughout the different stages of pregnancy, from planning conception to delivery and beyond, diabetes has a significant impact and probes important psychological issues that need to be addressed in diabetes care. In the early stage, women with established diabetes may experience increased stress levels related to their worries about possible birth defects that may interfere with family planning. Diabetic women who are pregnant are faced with increasing demands and scrutiny regarding fetal development, managing their diabetes as it responds to the pregnancy, and increased medical management. In gestational diabetes, women are confronted with a serious health problem that may involve insulin therapy, and elicit anxieties regarding the impact of the diabetes on the health of both the unborn child and the mother.

This chapter highlights some of the psychological issues involved in pregnancy in diabetes, with focus on women with pre-existing diabetes.

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