Twinning project: Israel and Georgia--the birth of a diabetes-in-pregnancy centre in Georgia.
OBJECTIVE
To determine the effectiveness of a joint Israeli-Georgian twinning project aimed at introducing modern methods of perinatal care to Georgian women with pregestational diabetes mellitus.


METHODS
A Diabetes-in-Pregnancy Centre was established in Georgia (in the former USSR). Thirty-two women with Type 1 diabetes mellitus participated in the first stage of the study (January 1997-June 1998). All were maintained under strict metabolic surveillance starting at least three months prior to conception and were given organized instruction in methods of self-monitoring of glucose levels, insulin dose adjustment, dietary management and close fetal surveillance throughout pregnancy. A second stage of the project was started in January 1998 and aimed at the diagnosis of gestational diabetes mellitus (GDM).


RESULTS
Of the 32 women, 20 had had a total of 44 prior pregnancies without proper perinatal care (1990-96); only five (11.3%) ended in the birth of a healthy infant. On entry to the study, all 32 patients had unsatisfactory metabolic indices. HbA1c levels decreased significantly from the preconception period (P<0.001) and were maintained at the lower level throughout pregnancy; insulin doses decreased significantly until the third trimester (P<0.01) and then increased (P<0.001). Since January 1997, 21 women have become pregnant. Eighteen have given birth, 12 (67%) by Caesarean section and six (33%) by vaginal delivery. Gestational age at birth was 36-39 weeks, and birth weight ranged from 2300 to 4100 g. The only neonatal complications were mild respiratory distress syndrome and hypoglycaemia. There were no significant maternal complications in the 236 women screened, eight were diagnosed as having GDM and 12 impaired glucose tolerance. They were actively managed to a successful outcome.


CONCLUSIONS
The establishment of the Diabetes-in-Pregnancy Centre in the Republic of Georgia has significantly reduced the prior high pre-programme perinatal morbidity and mortality as well as the incidence of maternal complications in pre-GDM as well as in GDM.
Hod
M
M
Department of Obstetrics and Gynecology, Rabin Medical Centre, WHO Collaborating Centre for Perinatal Care, Petah Tiqva, Israel.
Asatiani
N
N
Elphick
A
A
Kurashvili
R
R
Natsvlishvili
M
M
Chanturia
T
T
Bar
J
J
Peled
Y
Y
D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy*; D005260:Female; D005846:Georgia (Republic); D006801:Humans; D007391:International Cooperation; D007557:Israel; D008427:Maternal Health Services / Q000458:organization & administration*; D011181:Postnatal Care / Q000458:organization & administration; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000628:therapy*; D011295:Prenatal Care / Q000458:organization & administration