Gestational diabetes-perinatal outcome with a policy of liberal and intensive insulin therapy.
During 3 years of continuous screening for gestational diabetes mellitus in the county of Uppsala, 133 pregnant women (1.2%) were given this diagnosis. Maternal characteristics and the perinatal outcome of the pregnancies were examined retrospectively. Maternal overweight [body mass index greater than 23.9 kg/(m)2] was noted in 54.9% of the 133 women. Insulin therapy, with a mean daily dose of 42 U, was given to 62.4% of the patients, whereas the others were given dietary instructions alone. The frequency of infants with a birth weight greater than 2 SD was 24.1% and was significantly (p less than 0.025) related to pre-pregnancy overweight and also to pregnancy weight gain 18kg (p less than 0.01). Caesarean section was performed in 27% of the pregnancies complicated by diabetes, compared with the overall figure of 11% in Uppsala during the study period. Neonatal hypoglycaemia (blood glucose greater than or equal to 1.6 mM) was noted in 17.3% of the infants and was significantly (p less than 0.01) related to maternal sympathomimetic therapy. Despite liberal and intensive insulin therapy, there was a considerable rate of perinatal complications. Although not severe, they indicate a need for further improvement in the care of women with gestational diabetes.
Sunehag
A
A
Uppsala University Children's Hospital, Sweden.
Berne
C
C
Lindmark
G
G
Ewald
U
U
D016640:Diabetes, Gestational / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005320:Fetal Macrosomia / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007003:Hypoglycemia / Q000151:congenital / Q000209:etiology / Q000517:prevention & control; D007231:Infant, Newborn; D007328:Insulin / Q000627:therapeutic use*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology
D007328:Insulin