High spontaneous premature labor rate in insulin-dependent diabetic pregnant women: an association with poor glycemic control and urogenital infection.
The incidence of spontaneously occurring premature labor in insulin-dependent diabetic pregnancies is unclear, because previous studies have been confounded by a high rate of iatrogenic prematurity. The purpose of this study was to determine, in a large population of insulin-dependent diabetic pregnant women, the rate of spontaneous occurrence of premature labor and the various factors that may affect it. We hypothesized a priori that spontaneously occurring premature labor occurs at a high rate in insulin-dependent diabetic pregnant women, mainly because of poor control of diabetes during pregnancy, and is related to the presence of polyhydramnios and hypomagnesemia. One hundred forty-five insulin-dependent diabetic women undergoing 181 pregnancies were recruited since 1978 in an interdisciplinary prospective study. The goals of glucose control were a fasting blood glucose less than 100 mg/dL and a 90-minute postprandial glucose less than 140 mg/dL. The rate of spontaneous premature labor, 31.1%, was significantly higher (P less than .01) than that in a control population managed by the same obstetricians in similar clinical settings (20.2%). The following variables were not significantly associated with the onset of premature labor: maternal age, parity, gravidity, diabetic class according to White, presence of renal disease or retinopathy, previous elective abortion, chronic hypertension or pregnancy-induced hypertension, cigarette smoking, first-trimester or post-20 weeks' gestation vaginal bleeding, maternal serum magnesium concentration, or polyhydramnios.(ABSTRACT TRUNCATED AT 250 WORDS)
Mimouni
F
F
Department of Pediatrics, University of Cincinnati College of Medicine, Ohio.
Miodovnik
M
M
Siddiqi
T A
TA
Berk
M A
MA
Wittekind
C
C
Tsang
R C
RC
D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D002181:Candidiasis, Vulvovaginal / Q000097:blood / Q000150:complications; D003556:Cystitis / Q000097:blood / Q000150:complications*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications* / Q000628:therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007752:Obstetric Labor, Premature / Q000097:blood / Q000209:etiology*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011254:Pregnancy in Diabetics / Q000097:blood / Q000150:complications*; D011446:Prospective Studies; D012008:Recurrence; D012044:Regression Analysis; D012307:Risk Factors; D014247:Trichomonas Vaginitis / Q000097:blood / Q000150:complications; D014627:Vaginitis / Q000097:blood / Q000150:complications*
D001786:Blood Glucose; D006442:Glycated Hemoglobin