Treatment of pregnant insulin-dependent diabetic women

Abstract

The treatment of 620 insulin-dependent diabetic pregnant women is reported. The goal of treatment was to achieve a normal blood glucose concentration as soon as possibly during early, or even before pregnancy. When intensified conventional insulin therapy was started before conception, about 88% of the patients achieved normal blood glucose levels during the first weeks of pregnancy. In only about 20% of the pregnant diabetics without intensified preconceptional treatment a normal blood glucose level was obtained during their first hospitalization in pregnancy. The rate of congenital malformations was 1.1% in the former and 7.1% in the latter group.The treatment of the pregnant woman with insu¬ lin-dependent diabetes mellitus (IDDM) has com¬ pletely changed during the last 10 years. It is now generally accepted that the aim is to achieve tight metabolic control from the earliest weeks of preg¬ nancy and if possible even before conception. In this study we examined how many diabetic women who were able to achieve and maintain tight metabolic control during the preconceptional period and in the first trimester of pregnancy. Further, the influence of this optimized control on the rate of congenital malformations was eva¬ luated. Material and MethodsFrom 1977 to 1983 620 pregnant women with IDDM were treated and delivered in our hospital. 184 were under our care already before preg¬ nancy. They had been educated in home blood glucose monitoring, measurement of basal body temperature and about all other aspects of the treatment of diabetes in pregnancy during their first 'pre-pregnancy' hospitalization. After achiev¬ ing normal blood glucose levels they attended a special prepregnancy clinic and were admitted to hospital for a short period every 3 month until conception. In 436 women education and intensi¬ fied treatment was not started until after the eight week of pregnancy, that is after the critical period of embryogenesis.In all patients the aim was to achieve a blood glucose concentration comparable to that found in non-diabetic pregnant women.Our management of pregnant women with IDDM includes weekly attendance at the out¬ patient department and 5 to 7 short admissions to hospital during pregnancy, depending on the degree of metabolic control. Usually patients are seen at their weekly hospital visits by a specialist physician and obstetrician at their home town. On the whole these teams adhere strictly to our re¬ commendations and if necessary patients are referred back to us earlier than scheduled.

Morphohistometric investigations of placentas of diabetic patients in correlation to the metabolic adjustment of the disease

“…In contrast to LESLIE et al [12], but in agreement with O'SHAUGNESSY [22] and WORTH [30], we hold the view that HbA lc decreases in the course of normal pregnancy. FUHRMANN [5], LOWY [14], LESLIE [12], and NELSON [18] effectively demonstrated the correlation between blood glucose levels and fetal malformations, which is being confirmed in our comparatively small study group. In the same way macrosomia was mostly observed in mothers with bad metabolic conditions (seven out of eleven newborns) in our study group; whereas, five out of seven small-for-date babies in our collective were born to mothers in the White class D group.…”

Pre-pregnancy care for women with pre-gestational diabetes mellitus: a systematic review and meta-analysis

“…A total of 25 reports of 21 studies were included in this review [7,8,11-33]. (Three articles described the same cohort study with two interim [15,16] and one final report [17], one study reported the outcomes for the same cohort in two articles [7,27] and two articles report the outcomes of one cohort with one interim [29] and one final report [26]).…”

Preconception care for diabetic women for improving maternal and fetal outcomes: a systematic review and meta-analysis

“…A total of 24 reports of 20 studies were included in this review [10,12-34]. (Three articles described the same cohort study with two interim [17,18] and one final report [19], one study reported the outcomes for the same cohort in two articles [10,29] and two articles report the outcomes of one cohort with one interim [31] and one final report [28]).…”

“…In addition to glycemic control, 4 studies included screening and treatment of complications of diabetes in the PCC program [16,19,21,22]. Only one cohort study (two reports) had comprehensive PCC program including, control and self monitoring of blood glucose, folic acid supplementation, smoking cessation advice and discontinuation of teratogenic drugs [10,29].…”

“…Similarity of participants, intervention, and outcomes in addition to the score of low or medium risk of bias, made meta-analysis possible for12 cohort studies [10,15,16,19-21,23,25,26,28,32,33] with 2502 participants (Tables 1, 2&5 and Figures 2, 3, 4, 5, 6, and 7). Both dichotomous and continuous data were pooled but only when standard deviation and similar units were available for continuous data.…”