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1 St Mary’s Hospital for Women and Children, Manchester, UK 2 Manchester Diabetes Centre, Manchester, UK outcomes and risks of pregnancy, and the pros and cons of optimal glycemic control for mother and baby. The diabetes specialist dietitian updated her knowledge and skills on carbohydrate counting, and provided weight reduction and smoking cessation advice. She also had consultations with her diabetes physician and obstetrician.

Emma attended the diabetes center regularly over the next 6 months. Her progress was monitored by her diabetes specialist nurse and dietitian. After 4 months when her HbA1c was below 7% and with no significant hypoglycemia, her doctor advised her to stop contraception. Two months later a pregnancy test was positive and her care was immediately transferred back to the joint diabetes antenatal clinic. She was reviewed every 1–3 weeks at this clinic by the team, with phone call support between visits. At 35 weeks of gestation Emma developed hypertension and proteinuria which progressed in severity over the following weeks, requiring induction at 37 weeks. After successful management of her diabetes during labor using a glucose/insulin infusion according to a standard protocol she delivered normally a healthy baby.