Audit of the outcome of pregnancy in diabetic women in Soweto, South Africa, 1992-2002

Objective. To audit the outcome of pregnancy among diabetic black women in Soweto following the introduction of a specialised service. Design and methods. An analysis of patients' records was conducted for the period 1992-2002. Maternal characteristics, aspects of treatment and its complications, mode of delivery and perinatal outcome are reported. The incidence of postpartum glucose intolerance in women with gestational diabetes was assessed. Major outcomes from this study are compared with those of an earlier study conducted from 1983 to 1992. Results. A total of 733 diabetic pregnancies was managed over 11 years: 348 women had gestational diabetes, 172 had type 1 diabetes and 213 had type 2 diabetes. Insulin was used in all but 23 women. Mean (± standard deviation (SD)) capillary blood glucose levels varied between 5.7 (± 0.72) and 6.2 (± 0.95) mmol/l in the 3 groups. Severe maternal hypoglycaemia was most common in the type 1 diabetes group (14%). Mean (± SD) neonatal weight varied between 2 922.3 g (± 753) and 3 073.3 g (± 727). Caesarean section rates exceeded 60% in all 3 groups. Overall, 13.1% of women had hypertension, 31.3% of whom had proteinuric hypertension. There were no cases of progressive pre-eclampsia. The combined perinatal mortality (PMN) rate was 3.7%, compared with 15.6% in the 'control' group. Major congenital malformations occurred in 11 pregnancies (1.5%). There were 2 maternal deaths. Postpartum impaired glucose tolerance/diabetes occurred in 25.9% of women with gestational diabetes. Combining the 2 studies (1983-1992 and 1992-2002), 1 087 pregnancies were managed over 20 years using a similar protocol. There were no significant differences in major outcomes between the 2 studies. The overall PMN of 4.5% is significantly lower than that of the combined 'control' group (19.9%). Postpartum glucose intolerance was documented in 28.5% of women. Conclusions. The institution of a specialised service for pregnant diabetic women from Soweto for a sustained period of 20 years proved feasible and was of significant benefit. The interventions, centred around a diabetes nurse educator, were relatively simple and easy to implement. Late presentation/referral of patients remains a problem. Persistence of glucose intolerance postpartum in women with gestational diabetes was common and provides an opportunity for preventive measures to be introduced.