الفهرس 
BACKGROUNDOnly 14 pages are availabe for public view
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Abstract
We can find in this study the difference between the effect of tight and less tight control of DM on pregnancy outcomes so we find decrease in the rate of C.S, congenital anomalies,low of GA, macrosomia, operative vaginal delivery, small for GA, admission to neonatal ICU and respiratory distress syndrome than in less tight group .
There is no difference between two control groups on fetal death and neonatal death .
Comparing the different intensities of glycaemic control for pregnant women with pre-existing diabetes has been focuses of randomized controlled trials.
To assess the effects of different intensities in pregnant women, optimal glycaemic target in pregnant women with diabetes is unclear, but there is a link between high glucose concentrations and adverse birth outcomes.
Few differences in outcomes were seen, there is evidence of harm more feasible particularly for pregnant women with less tight glyceamic control. The metabolic disruptions to the fetus caused by the mother’s high blood sugars and insulin resistance can affect the development of organs, and cardiovascular malformations are the most common birth defects in infants born to diabetic mothers. Infants of diabetic mothers may also be at increased risk of developing obesity and type 2 diabetes.
Management of diabetes in pregnancy therefore aims for tight control of glucose (glycaemic control) using careful combinations of diet, exercise, insulin or other anti-diabetogenic drugs, clinical visits and monitoring.
Interventions such as monitoring may be successful in helping women to manage their diabetes.
Women who have either type 1 or type 2 diabetes before they become pregnant have an increased risk of pregnancy loss, high birthweight babies and perinatal deaths.
We found very few differences between very tight and tight glucose targets in trials, although there were significantly more cases of low blood sugar (hypoglycaemia) and longer hospital stays for women who had very tight blood sugar control.
It is clearly difficult for women to achieve glucose targets in is olation, and interventions such as monitoring may be successful in helping women to manage their diabetes.
The risks of severe hypoglycemia associated with strict glycemic control of patients.
As with diabetes mellitus in pregnancy in general, babies born to mothers with gestational diabetes are typically at increased risk of problems such as being large for gestational age (which may lead to delivery complications), low blood sugar, , jaundice,.
Gestational diabetes is a treatable condition and women who have adequate (tight) control of glucose levels can effectively decrease these risks.
Women with gestational diabetes are at increased risk of developing a higher incidence of pre-eclampsia and
Caesarean section; . Most patients are treated only with tight control may increase the risk of those complications but there is decrease the risk in the very tight control
The goal of treatment is to reduce the risks of GDM complications for mother and child. Scientific evidence is beginning to show that controlling glucose levels can result in less serious fetal complications (such as macrosomia) and increased maternal quality of life.
Very tight control was associated with more frequent episodes of hypoglycaemia than was tight control.
No benefits of very tight over tight control were detected in terms of maternal morbidity.
There is a trend towards better metabolic outcomes but no differences in perinatal outcome are demonstrated.