Rigorous management of insulin-dependent diabetes mellitus during pregnancy

S. W. Aucott, T. G. Williams, R. H. Hertz, S. C. Kalhan

Research output: Contribution to journalArticle

Abstract

The effect of rigorous management of insulin-dependent diabetes mellitus (IDDM) during pregnancy on the perinatal outcome was assessed by comparing 78 prepartum gravid patients with IDDM managed prospectively with 78 matched controls. The diabetic women were treated with insulin by either infusion pump or split-dose therapy, with the goal of normalization of the fasting blood sugars and hemoglobin Hb A1c values. Differences in the perinatal outcome were evaluated by either chi-square or analysis of variance. Of the women with IDDM, 14% where White class B, 43% class C, 26% class D, 17% classes R and F. The mean Hb A1c value in the first half of pregnancy was 8.49%±2.30%, and 7.34%±1.79% in the second half. Women with IDDM had higher rates of premature delivery (31% vs. 10%, P=0.003), pre-eclampsia (15% vs. 5%, P=0.035), and cesarean section (55% vs. 27%, P=0.002). Complications of infants born to diabetic mothers included large size for gestational age (41% vs. 16%, P=0.0002), hypoglycemia (14% vs. 1%, P=0.0025), hyperbilirubinemia (46% vs. 23%, P=0.0002), and respiratory distress (12% vs. 1%, P=0.008). The Apgar scores and mortality were similar. Congenital malformations occurred in 7.7% of infants of diabetic mothers and 1.3% of controls (P=0.05). The maternal Hb A1c level did not correlate with the infant size for gestation. Although the improved medical management of IDDM has decreased neonatal mortality, significant perinatal complications persist.

Original languageEnglish (US)
Pages (from-to)126-129
Number of pages4
JournalActa Diabetologica
Volume31
Issue number3
DOIs
StatePublished - Sep 1 1994
Externally publishedYes

Keywords

  • Infant of diabetic mother
  • Insulin-dependent diabetes mellitus

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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