Seven Years Experience of Home Management in Pregnancy in Women with Insulin‐dependent Diabetes

Abstract

Fifty-eight of a consecutive series of 75 pregnancies in women with insulin-dependent diabetes went into the third trimester. Diabetes was managed by home blood glucose monitoring and women were not routinely admitted at any stage before delivery. The mean number of in-patient days before delivery was 15 for the whole series but has been reduced to 9 during the past four years. Each woman performed an average of 171 blood glucose measurements during her pregnancy. Mean blood glucose (including post-prandial levels) fell significantly from 7.9 mmol/l in the first trimester to 7.3 in the second and 6.4 in the third. Mean percentage of haemoglobin A1 was within the normal range in the second and third trimesters. The cesarean section rate was high at 66% but there were no perinatal deaths. Three infants had congenital abnormalities. We conclude that home blood glucose monitoring is a safe and effective way of managing pregnant diabetic women as out-patients. The cost of meters and sticks is repaid many times over in the saving of hospital costs. In addition, home blood glucose monitoring is popular with the patients and many choose to continue it after delivery.

Diabetes in pregnancy 1985

“…The incidence of neonatal complications was not much different between the two groups, and neither was the degree of m~ernal blood glucose control or evidence of fetal hyperinsulinism. This accords with the experience in Nottingham [24], where it was found that the~cost of mefErs and strips was repaid many times over in the saving of hospital costs, to say nothing of patient popularity.…”

“…Other factors such as better nutrition, improved social circumstances, and recognition of the risks of smoking and of alcohol must play a part. Skyler [26] states dogmatically that the advent of patient self-monitoring of plasma glucose has made the desired metabolic normality feasible and practical, but Tattersall and his colleagues [24], during 7 years experience of home monitoring in diabetic pregnancy, were unable to prevent the occurrence of three serious congenital abnormalities in 58 pregnancies. They recognised that completely normal mean blood glucose levels were not achieved in any trimester or at any time of the day, but the mean haemoglobin A, did fall into their normal range (5.5-8.5%) in the second and third trimesters.…”

Computerized and telemetric management of diabetic pregnancy in Cambridge

“…In our study, neonatal complications were uncommon and none was serious. The incidence of neonatal hypoglycaemia was 12%, which is similar to that in other series [9,15]. Interestingly, we have been able to confirm the finding of KNIGHT et al [12] that fetal macrosomia is not necessarily associated with poor diabetic control in the mothers.…”

“…The overall outcome of pregnancy in our series was good, with no significant maternal or fetal complications. Our overall Caesarean section rate was only 23%, which compares favourably with a rate of 66% in HELLER et al's series [9], although DRURY [7] did achieve a rate of only 20%. In our study, neonatal complications were uncommon and none was serious.…”

Macrosomia in Pregnancy Complicated by Insulin-Dependent Diabetes Mellitus

“…Despite attention to all these measures, macrosomia will still occur but should not be associated with significant perinatal complications if the patient has achieved good glycemic control in the latter half of pregnancy and if neonatal hypoglycemia is rapidly detected and corrected. Even if good glycemic control in pregnancy will not guarantee the birth of a nonmacrosomic infant, there is such compelling evidence that meticulous diabetic control reduces perinatal morbidity and mortality that euglycemia remains the therapeutic aim for every diabetic patient during pregnancy (8,19,(27)(28)(29)(30)(31).…”