Impact of maternal euglycemia on fetal outcome in diabetic pregnancy

Abstract

We examined the relationship between maternal euglycemia and fetal outcome in 81 cases of gestational, diet-controlled (GD) diabetes and 32 cases of insulin-dependent diabetes (IDD). The perinatal mortality rate was reduced from 2.3% to zero in an 18 month period ending in December 1977. Perinatal morbidity in GD and IDD was comparable and independent of age, parity, and severity of diabetes. Fasting maternal glucose concentrations correlated positively with the incidence of fetal macrosomia (p = < 0.025) which in this study was 8%. While neonatal hypoglycemia of less than 24 hours' duration affected 28% of the neonates, its incidence was also greater in the GD group as was macrosomia. Congenital malformations occurred in 4% of cases and were found exclusively in GD. These studies confirm our previous observations supporting the hypothesis that the control of the maternal glucose concentration is the single most important aspect in the management of the pregnant diabetic patient. With such control the perinatal mortality rate approaches zero with the outcome of pregnancy being equal for all diabetic patients. On the other hand, neonatal morbidity can be expected to be higher in women with gestational diabetes identified late in pregnancy. Likewise, congenital malformations in this group may represent the influence of uncontrolled glucose metabolism in the early months of gestation which remained undetected due to late registration for prenatal care.