Diabetic pregnancy and perinatal morbidity

Pregnancy outcome was analyzed in 147 diabetic women, 71 per cent of whom were dependent on insulin for more than 10 years. Ambulatory management of diabetes was carried out with weekly clinic visits until hospitalization at 36 to 37 weeks' gestation. Modern methods of fetal assessment were applied, and the timing and route of delivery were individualized. Of these patients, 35 per cent were delivered at or beyond 38 weeks' gestation. The primary cesarean section rate was 55 per cent. Polyhydramnios was a frequent maternal complication and was associated with premature labor and neonatal death in two cases. Polyhydramnios was least common in women with the lowest mean outpatient blood glucose. The perinatal survival rate was 96.6 per cent, and there were no instances of unexpected intrauterine fetal death. The incidence of respiratory distress syndrome (RDS) in the newborn infant was 7.6 per cent. No severe RDS was seen when the lecithin/sphingomyelin (L/S) ratio was greater than 3.0, but three of 24 infants delivered with an L/S ratio of 2.1 to 3.0 developed severe RDS. Other forms of neonatal morbidity noted in this population were 9 per cent major congenital anomalies; 7 per cent transient tachypnea of the newborn, 22 per cent hypocalcemia, 19 per cent hyperbilirubinemia, and 47 per cent hypoglycemia. The latter was more common in macrosomic infants, defined as greater than the ninetieth percentile of birth weight for gestational age (LGA), who represented 36 per cent of the neonates. Mean outpatient postprandial blood glucose was higher in patients delivered of LGA infants and was correlated with birth weight in White Classes B to D.