Metabolic control and pregnancy outcome among women with insulin-dependent diabetes mellitus. A twelve-year follow-up in the country of Jämtland, Sweden.
OBJECTIVE
To assess metabolic control and pregnancy outcome in women with insulin-dependent diabetes mellitus (IDDM) in a defined rural area of Sweden and to compare results for three four-year periods (1982-85, 1986-89, 1990-93).


METHODS
All pregnancies in women with IDDM during the 12-year period, 1982-93, received their antenatal care from a 'diabetic team' at the County Hospital, Ostersund. There were 50 women in the series, accounting for a total of 91 pregnancies. Spontaneous or induced abortions occurred in 19 cases. Case notes from maternity, neonatal and pediatric care were retrospectively scrutinized.


RESULTS
In period one 31% of the pregnancies occurred in gravidae with diabetes classified as White D, F or R, as compared with 46% and 71% during periods two and three (p=0.001). Maternal hypertension was also more frequent in period three (12%, 26% and 54%, respectively; p=0.001). Fewer antenatal admissions (p=0.02) but more frequent ultrasound scannings (p=0.014) were recorded for period three. HbA1c levels decreased continuously from prepregnancy through first and third trimesters (9.7%, 8.4%, and 7.4%, respectively; p<0.0001). Perinatal mortality and frequencies of congenital malformations were both 4.2% (95% CI 0.5-8.8%), whereas the miscarriage rate was 14.3% (95% CI 6.8-21.8%).


CONCLUSIONS
As compared with the first 4-year period, 1982-85, the third period, 1990-93, was characterized by a greater proportion of gravidae with more serious diabetes and a higher rate of pregnancy complications, though the outcome was nonetheless good, suggesting the diabetic pregnancy care program to have been efficacious.
Nordström
L
L
Department of Obstetrics & Gynecology, County Hospital, Ostersund, Sweden.
Spetz
E
E
Wallström
K
K
Wålinder
O
O
D000328:Adult; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000453:epidemiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011256:Pregnancy Outcome; D011254:Pregnancy in Diabetics / Q000097:blood / Q000453:epidemiology* / Q000628:therapy; D015995:Prevalence; D012189:Retrospective Studies; D012424:Rural Population / Q000706:statistics & numerical data; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors
D006442:Glycated Hemoglobin