[Diabetes before pregnancy, apropos of 143 cases].
OBJECTIVE
The authors want to appraise the management of diabetes prior to pregnancy in a local population treated in the Lille University Hospital.


METHODS
This is a retrospective study of 143 pregnancies occurring in 111 patients with diabetes prior to pregnancy, between 1987 and 1997, in the Obstetrics Department at the Lille University Hospital.


RESULTS
Only one-third of the patients benefited from preconception management; the stability of diabetes during the first trimester was satisfactory in 50% of the cases. The maternal complications are represented by preeclampsia (20%), metabolic complications specific to diabetes (hypoglycemia, ketoacidosis), the aggravation or the emergence of a retinopathy (10%) and polyhydramnios (19%). Concerning the termination of the pregnancies, of the 147 fetuses (four twin pregnancies), 140 newborns in good health, two neonatal deaths, three in-utero deaths and two therapeutic terminations of pregnancy were observed. The fetal malformation rate was 9.5% (14 cases/147). The cesarean section rate was 63%, whereas the fetal macrosomatia rate was 35%, with dystocia in 26% of the deliveries (outside of planned cesareans). Three shoulder dystocia were observed (two requiring the Jacquemier's maneuver and one with transitory plexus brachial palsy for a newborn weighing 5,650 g).


CONCLUSIONS
The authors conclude that preconception management (one-third of the patients in this series) and management of during the first trimester of pregnancy (50% in this series) was insufficient. This fact is perhaps due to the confusion, for many practitioners, with gestational diabetes, which is a very mediatized affection, though much less severe for the fetus and mother.
Jouatte
F
F
Hôpital Jeanne-de-Flandre, CHRU de Lille, France.
Aitken
B
B
Dufour
P
P
Valat
A S
AS
Vamberghe
A
A
Cappoen
J P
JP
Leroy
R
R
Puech
F
F
Monnier
J C
JC
D000293:Adolescent; D000328:Adult; D000013:Congenital Abnormalities / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology; D016742:Preconception Care; D011247:Pregnancy; D011248:Pregnancy Complications; D011254:Pregnancy in Diabetics / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies