title: [Diabetes before pregnancy, apropos of 143 cases].
abstract: 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.
authors.affiliation: Hôpital Jeanne-de-Flandre, CHRU de Lille, France.
authors.forename: F
authors.initials: F
authors.lastname: Jouatte
authors.forename: B
authors.initials: B
authors.lastname: Aitken
authors.forename: P
authors.initials: P
authors.lastname: Dufour
authors.forename: A S
authors.initials: AS
authors.lastname: Valat
authors.forename: A
authors.initials: A
authors.lastname: Vamberghe
authors.forename: J P
authors.initials: JP
authors.lastname: Cappoen
authors.forename: R
authors.initials: R
authors.lastname: Leroy
authors.forename: F
authors.initials: F
authors.lastname: Puech
authors.forename: J C
authors.initials: JC
authors.lastname: Monnier
mesh_terms: 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