Summary: Epidermolysis bullosa (EB) is a rare inherited skin condition characterized by the development of blisters after minor mechanical friction or trauma. There are few reported pregnancies in the literature in these women. We describe a pregnancy we recently managed. The collated series of pregnancies show that there are no additional antenatal or postnatal problems and that the skin itself does not worsen during pregnancy. Vaginal delivery is most favourable, but if a caesarean section is required, regional anaesthesia should be attempted. A multidisciplinary team should be active throughout the pregnancy of these women and a well-documented labour plan should be made in advance.

With appropriate multi-disciplinary team care, most women with diabetic nephropathy will have successful pregnancy outcomes; however, pregnancy complications are increased compared to non-diabetic individuals, particularly in those with poor glycaemic control. Women with more severe renal impairment, especially those with hypertension and proteinuria at are highest risk of worse pregnancy outcomes and deterioration in pre-existing renal function. Pre-pregnancy counselling should be offered to all women with diabetes in order to optimise diabetic care, and inform women of potential complications. Pregnancy is an indicator of long-term health, and may indicate important issues for the future management of women with diabetic nephropathy.

Introduction International evidence shows that Asians have increased diabetes risk at a lower body mass index (BMI) than European Whites.1 UK guidance for routine gestational diabetes screening does not consider this BMI difference in risk. A proportion of high risk Asian women are therefore unscreened for diabetes in pregnancy, and potentially wrongly assigned to low risk care leading to inequalities. This study describes trends in first trimester obesity using the WHO BMI criteria for Asians. Methods Retrospective epidemiological study using data from 34 maternity units in England between 1995 and 2007. Obesity classification was BMI >27.5 kg/m2 for Asians, and >30 kg/m2 for all other ethnic groups. χ2 analyses were used for trends over time. Logistic regression for odds of first trimester obesity among ethnic groups adjusted for maternal age, parity, deprivation and employment. Results Black and South Asian women have a significantly higher incidence of first trimester obesity compared with White women, and this is increasing at a more rapid rate over time in Black women. The proportion of South Asian women classified as obese doubled from 10.6% to 20.5% when using the WHO criteria for Asians compared with the general population BMI. Following adjustment for population demographics, Pakistani women had the highest odds of first trimester obesity (OR 2.19, 95% CI 2.08 to 2.31). Conclusion Current gestational diabetes screening in the UK excludes half of the South Asian population at high risk. There should be further consideration of ethnic groups when defining the BMI categories to be used when developing clinical guidelines and services.

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