PAIGE resulted in significantly greater weight loss at 6 months compared with usual care. Such weight loss could prove beneficial in terms of better long-term health and subsequent prevention of type 2 diabetes in overweight women with previous GDM. Future interventions must consider recruitment strategies, timing of the intervention, and inclusion of partners and/or other family members.

AimsTo assess the effect of pregnancy planning on maternal and neonatal outcomes in women with Type 1 diabetes.MethodsPregnancy planning was assessed retrospectively in a cohort of women who participated in the Diabetes and Pre‐eclampsia Intervention Trial (DAPIT). Pregnancy planning was determined based on self‐report as to whether pregnancy was planned or unplanned. The effect of pregnancy planning on maternal and neonatal outcomes was examined, controlling for confounding variables.ResultsA total of 747 women were included in the study, of whom 39% considered their pregnancy unplanned. Characteristics associated with unplanned pregnancy included being younger (P<0.001), being a current smoker (P<0.001), being from a lower social class (P<0.001) and having higher HbA1c values prior to and throughout pregnancy (P≤0.005). Significantly fewer women with unplanned vs planned pregnancies received pre‐pregnancy counselling (24% vs 64%; P<0.001). Infants of women with unplanned pregnancies were more likely to be small for gestational age (<5th centile; P=0.004), to be admitted to the neonatal care unit (P=0.001) and to have a longer stay in hospital (P=0.01). Outcomes did not differ between the groups in relation to pre‐eclampsia, congenital malformations or a composite adverse outcome.ConclusionsRisks associated with diabetes in pregnancy need to be highlighted to all women, their partners and families, and healthcare professionals. Further research is required to determine if these groups are fully aware of the risks associated with diabetes in pregnancy.

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OBJECTIVETo examine the association between fatty acid binding protein 4 (FABP4) and preeclampsia risk in women with type 1 diabetes. RESEARCH DESIGN AND METHODSSerum FABP4 was measured in 710 women from the Diabetes and Pre-eclampsia Intervention Trial (DAPIT) in early pregnancy and in the second trimester (median 14 and 26 weeks' gestation, respectively). RESULTSFABP4 was significantly elevated in early pregnancy (geometric mean 15.8 ng/mL [interquartile range 11.6-21.4] vs. 12.7 ng/mL [interquartile range 9.6-17]; P < 0.001) and the second trimester (18.8 ng/mL [interquartile range 13.6-25.8] vs. 14.6 ng/mL [interquartile range 10.8-19.7]; P < 0.001) in women in whom pre-eclampsia later developed. Elevated second-trimester FABP4 level was independently associated with pre-eclampsia (odds ratio 2.87 [95% CI 1.24-6.68], P = 0.03). The addition of FABP4 to established risk factors significantly improved net reclassification improvement at both time points and integrated discrimination improvement in the second trimester. CONCLUSIONSIncreased second-trimester FABP4 independently predicted pre-eclampsia and significantly improved reclassification and discrimination. FABP4 shows potential as a novel biomarker for pre-eclampsia prediction in women with type 1 diabetes.Pre-eclampsia, defined as new-onset hypertension and proteinuria occurring after 20 weeks of gestation, is associated with significant perinatal morbidity and mortality (1,2). Pre-eclampsia is two to four times more likely to develop in women with type 1 diabetes than in the background population (3,4).Fatty acid binding protein 4 (FABP4), or adipocyte FABP, is an intracellular lipid chaperone involved in coordination of lipid transportation (5). FABP4 is expressed mainly in adipocytes and can be released into the circulation (6). In the nonpregnant state, FABP4 is associated with the following known pre-eclampsia risk factors: obesity, hypertension, and diabetes (6,7).Several studies have reported elevated FABP4 levels in women with pre-eclampsia (8,9) or in those in whom pre-eclampsia later developed (10), compared with those in whom it did not, although all studies excluded women with diabetes.Our objective was to examine the role of FABP4 as a potential biomarker for preeclampsia alone, and in tandem with established clinical risk factors, in women with type 1 diabetes.