Poor glycemic control and antepartum obstetric complications in women with insulin-dependent diabetes.
OBJECTIVE
The purpose of this study was to test the hypothesis that the rate of complications of pregnancy in women with insulin-dependent diabetes is higher than in nondiabetic women and is associated with poor glycemic control and microvascular disease.


METHODS
Women who enrolled in a multidisciplinary program of diabetes in pregnancy prior to 20 weeks' gestation were included in the study and matched 1:2 by age, race and parity to a control group of nondiabetic women. Complications of pregnancy were retrospectively analyzed and compared between groups. The association of complications with glycemic control and microvascular disease was analyzed within the diabetic group.


RESULTS
Women with diabetes had significantly higher rates of pregnancy-induced hypertension (PIH), polyhydramnios, pyelonephritis, preterm delivery and meconium-stained amniotic fluid. Poor glycemic control, particularly during the first and second trimesters of pregnancy, was associated with all complications, except pyelonephritis. Microvascular disease was associated with PIH and preterm delivery prior to 34 weeks.


CONCLUSIONS
Women with insulin-dependent diabetes are at high risk for complications of pregnancy. Glycemic control during the first and second trimesters may affect events later in pregnancy.
Rosenn
B
B
Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Ohio.
Miodovnik
M
M
Combs
C A
CA
Khoury
J
J
Siddiqi
T A
TA
D001786:Blood Glucose / Q000032:analysis*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D016555:Matched-Pair Analysis; D007752:Obstetric Labor, Premature / Q000453:epidemiology; D006831:Polyhydramnios / Q000453:epidemiology; D011225:Pre-Eclampsia / Q000453:epidemiology*; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000150:complications / Q000628:therapy*; D011704:Pyelonephritis / Q000453:epidemiology; D012189:Retrospective Studies; D012306:Risk
D001786:Blood Glucose