Can prepregnancy care of diabetic women reduce the risk of abnormal babies?

Abstract

controlled for in the multivariate analvsis. Furthermore, the suggested risk factors occurring later in life, such as psychological mechanisms and drug availability and exposition, cannot explain the demonstrated associations between administration of drugs during the perinatal period and subsequent addiction in offspring. Also, genetic and socioeconomic factors were largely controlled for by matching addicts with their own siblings.In conclusion, effective pain relief is sometimes an important factor for a successful outcome of delivery, as well as for the ability of the mother to accept and care for the child in the future. At present, when considering the choice of analgesic method immediate risks and benefits are mainly taken into account. When depressant or sedative drugs are used their possible long term effects due to imprinting also seem to be important. From this point of view, analgesic methods not associated with passage of substantial amounts of drugs across the placenta are preferable. Our Abstract Objective-To see whether a prepregnancy clinic for diabetic women can achieve tight glycaemic control in early pregnancy and so reduce the high incidence of major congenital malformation that occurs in the infants of these women. Design-An analysis of diabetic control in early pregnancy including a record of severe hypoglycaemic episodes in relation to the occurrence of major congenital malformation among the infants.Setting-A diabetic clinic and a combined diabetic and antenatal clinic of a teaching hospital.Patients -143 Insulin dependent women attending a prepregnancy clinic and 96 insulin dependent women managed over the same period who had not received specific prepregnancy care.Main outcome measure-The incidence of major congenital malformation.Results-Compared with the women who were not given specific prepregnancy care the group who attended the prepregnancy clinic had a lower haemoglobin Al concentration in the first trimester (8.4% v 10-5%), a higher incidence of hypoglycaemia in early pregnancy (38/143 women v 8/96), and fewer infants with congenital abnormalities (2/143 v 10/96; relative risk among women not given specific prepregnancy care 7-4 (95% confidence interval 1-7 to 33.2)).Conclusion-Tight control of the maternal blood glucose concentration in the early weeks of pregnancy can be achieved by the prepregnancy clinic approach and is associated with a highly significant reduction in the risk of serious congenital abnormalities in the offspring. Hypoglycaemic episodes do not seem to lead to fetal malformation even when they occur during the period of organogenesis.

Transient Improvement in Glycemic Control: The impact of pregnancy in women with IDDM

“…Eleven (37%) women failed to attend their first postnatal appointment (between 2 and DIABETES CARE, VOLUME 21, NUMBER 3, MARCH 1998 (9) .0 (10) .6(11) .3 (12) .8 (14) .7 (15) .0 (15) .2 (15) .0 (15) .4 (14) .9 (6) . 4 .3 (6) .7 (9) .4(9) •3 (11) .6 (12) .0 (13) .5 (13) .8 (13) .5 (13) •7 (11) .0(9 3 months after delivery), but data were eventually obtained for 26 (87%) women for the period 0-6 months after delivery and for 15 (50%) women for the period up to 1 year after delivery. Five women (17%) embarked on another pregnancy during the postpartum period of study and were excluded from the analysis.…”

“…Combined obstetric/diabetes clinics and the introduction of preconception counseling appear to have gone partway to meeting the aims of the St. Vincent Declaration, and there is evidence that the improved glycemic control achieved during pregnancy has reduced both maternal and infant morbidity (5,11). Although improved glycemic control during pregnancy is possible to achieve, there are limited data on the specific degree of glycemic control achieved by women after pregnancy.…”

Krampfanfall und Koma bei Schwangeren und Wöchnerinnen

“…Im ersten Trimenon steigt bei Diabetikerinnen die Rate an Hypoglykä-mien von 25 auf 41%, die Episoden mit hypoglykämischen Koma von 9 auf 19% und die Rate an reduzierter Hypoglykämie-Wahrnehmung von 16% präkonzeptio-nell auf 35% [8]. Vorkommen können Verkehrsunfälle, Grand-Mal-Krampfanfälle, Hirnödeme [29] und Todesfälle durch gesicherte Hypoglykämien, auch das "Todim-Bett"-Syndrom, dem protrahierte Hypoglykämien zugrundeliegen können [20] Schwere Hypoglykämien mit Blutglukosewerten <1,1 mmol/l (<20 mg/dl) sind einer schweren Hypoxie gleichzusetzen, da die Substratversorgung der Nervenzellen erlischt und dies analog wie bei der Hypoxie bereits nach 5 Minuten zu einer irreversiblen Schädigung des ZNS führen kann [21]. Aber auch unmittelbar vor und unter der Geburt sinkt der Insulinbedarf drastisch ab und liegt im Wochenbett nur noch bei etwa 50% von dem Bedarf in der Spätschwangerschaft.…”

Das Neugeborene der diabetischen Mutter

“…Bei einer Stoffwechselkorrektur, die erst postkonzeptionell im 1. Trimenon einsetzte, stieg die Miûbildungsrate wieder deutlich auf 7,5±10,4 % an [9,16,39].…”