Diabetes Management Before and During Pregnancy: Preface

P R A C T IC E For many women, pregnancy is a time of heightened awareness about the importance of selfcare. Women generally have a strong desire to do what is best for their growing baby and will often make positive choices towards healthy behaviors during what they know is a crucial time in their baby’s development. Smoking cessation is a great example of how powerful the “pregnancy motivating factor” can be. Women who have failed at attempts to quit smoking before pregnancy often are able to muster the ability to finally do it. There is no disputing that quitting smoking benefits both mother and child. Yet, surprisingly, evidence is not as robust for other aspects of selfcare and prenatal care. For example, determining the optimal nutritional prescription for women with gestational diabetes mellitus (GDM) conventionally has involved limiting carbohydrate intake. Optimal carbohydrate intake during pregnancy is one of several important topics that are discussed in this Diabetes Spectrum From Research to Practice section, which provides an update on the management of individuals with diabetes before and during pregnancy. On the topic of carbohydrate consumption during pregnancy, the research of Teri L. Hernandez has certainly called into question the notion that, when it comes to carbohydrates, fewer is always better. Her article titled “Nutrition Therapy in Gestational Diabetes: The Case for Complex Carbohydrates” (p. 82) discusses this topic. Dr. Wadia R. Mulla then provides a counterpoint in her commentary on why lowcarbohydrate diets should remain a recommendation for women with GDM (“Low-Carbohydrate Diets Should Remain the Initial Therapy for Gestational Diabetes,” p. 89). If medical nutrition therapy alone does not achieve satisfactory blood glucose control during pregnancy, what pharmacological agents can be used as adjuncts? In the past, insulin was the automatic drug of choice in pregnancy, which is discussed in an article titled “Insulin Use in Pregnancy: An Update” by Alyson K. Blum (p. 92). However, in their article titled “Oral Medications for Diabetes in Pregnancy: Use in a Rural Population” (p. 98), Shelley Jayne Thorkelson and Kristi R. Anderson point out that many clinicians are now using oral agents as first-line pharmacological therapy during pregnancy. Another important, but sometimes overlooked, aspect of diabetes care during pregnancy is the effect of economic and social disparities on health outcomes. The results of a randomized, controlled trial that my colleagues and I report in a feature article elsewhere in this issue (“Macronutrient Composition or Social Determinants? Impact on Infant Outcomes With Gestational Diabetes Mellitus,” p. 71) highlight the need for further study in this area. In our research section, authors Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA