Course of diabetes during pregnancy.

Abstract

There has been some difference of opinion regarding the course of diabetes during pregnancy. During the pre-insulin era, diabetic coma was the outstanding feature (Offergeld, 1908; Joslin, 1924). Reports from the twenties emphasized mainly those cases in which an improvement occurred, and this gave rise to the idea that the foetal insulin production could in part replace that of the mother (Holzbach, 1926; Gray & Feemster, 1926). Pregnancy was then very uncommon among diabetics, but its incidence has increased, particularly during the past decade (Fig. 1). Most authors now report series of 30 to 50 cases, and it is generally held that the course of diabetes may vary (Skipper, 1933; Duncan & Fetter, 1934; White, 1937; Lawrence & Oakley, 1942; Andersson, 1950). In most cases an exacerbation takes place, particularly during the latter half of pregnancy. Improvement occurs in some instances and the condition remains unchanged in others. White (1946), who has most experience, has stated that the insulin requirements increase with each trimester. There seems to be least difference of opinion as to the course during the first puerperal days, when the insulin requirement is greatly reduced. It is also agreed that pregnancy does not permanently alter the severity of diabetes.