PREGNANCY AND DIABETES

Abstract

Abstract A review of 106 patients with 131 pregnancies complicated by diabetes has been presented. Past history of the multigravid patients indicated that the infants of the prediabetic mothers tended to be larger than average. The pregnancy of 75 per cent of the patients terminated after thirty-six weeks. Weight gain was not excessive in general for those patients who registered in the first and second trimesters, but was excessive in two-thirds of the patients who registered in the last trimester. Toxemia was present in 46 per cent of the pregnancies, keto-acidosis in 16.8 per cent. The diabetes was treated by the clinical technique. There was no constant diminution of insulin requirements observed during pregnancy. Labor was prolonged in 26 per cent of our primigravid patients and in 1.3 per cent of our multigravid patients. Incidence of forceps was 10 per cent, of cesarean section, 9.9 per cent. The sections were performed for obstetrical indications. Maternal mortality was 1.5 per cent, represented by 2 patients, in neither of whom was the diabetes the initiating cause of death. Maternal morbidity was 17 per cent. The infants were routinely sent to the pediatric premature nursery where incubation, oxygen, suction, and dehydration formed the initial regimen of treatment. Thirty and six-tenths per cent of the infants weighed over 4,000 grams. The infant mortality rate was 21.4 per cent, the total fetal loss was 30 per cent * Errors were often made in estimating the size of the infant and death resulted from the traumatic delivery of impacted shoulders. We believe that delivery should be accomplished at the first sign of developing toxemia, if the pregnancy is past thirty-two weeks. Further, the patient who has been poorly controlled and has had bouts of keto-acidosis should be delivered prematurely. Delivery should be effected by induction of labor when conditions are ideal, otherwise by cesarean section. In the patient with a large infant, or in the case where there is some question as to the size, cesarean section is the procedure of choice.