Effect of euglycemia on the outcome of pregnancy in insulin-dependent diabetic women as compared with normal control subjects

Abstract

A comparative study was performed to evaluate the effect of a euglycemia program instituted prior to the 12th week of pregnancy in 52 diabetic women (White class B or greater). The comparison group consisted of 52 nondiabetic women of the same ethnic background, chosen serially over the period of study, who presented to the same clinic and delivered in the same fashion. Euglycemia in the diabetic group was documented by daily home-monitored glucose determinations and bimonthly hemoglobin A 1c levels, and 24-hour glucose profiles and urinary collections during periods of hospitalization, at presentation, 20 or 26 weeks, and at term. All but two women with diabetes agreed to follow the program. There was no fetal loss in the diabetic group, and mean percentile body weight was slightly less (58 percent compared with 62 percent, p = NS) than that of the offspring of the nondiabetic clinic comparison group. Infants of diabetic mothers who had vascular disease (White classes D 4, R and F) were smaller than infants of mothers from White classes B, C 1, BG and CG (p < 0.001). There was one blood glucose level of less than 45 mg/dl in one infant of a diabetic mother. None had a bilirubin level of more than 12 mg/dl versus the five in the control group (p = 0.03). No infant in the diabetic group had erythremia (hematocrit of more than 65 percent) or respiratory distress versus four with (p = 0.06) and five with (p = 0.03), respectively, in the clinic population. Only one infant in the comparison group and none in the diabetic group showed evidence of hypocalcemia (p = NS). The present study indicates that problems of morbidity and mortality are minimized if patients with diabetes are maintained euglycemic from the 12th gestational week on. The results of this comparative study was consistent with the hypothesis that if hyperglycemia is eliminated as a variable in diabetic pregnancy, outcome is determined by the quality of antenatal care rather than the presence of diabetes mellitus per se, even though patients in White classes D 4, R and F may deliver slightly smaller infants than diabetic mothers without concomitant vascular disease. Mothers in White classes D, R and F were found to have higher initial mean blood glucose levels and hemoglobin A 1c levels than the other diabetic women. Whether earlier establishment of euglycemia will eliminate the problems of growth retardation, fetal wastage and congenital malformation remains to be determined.