Perinatal mortality in diabetic patients undergoing antepartum fetal evaluation: a case-control study.
OBJECTIVE
To identify changing trends, if any, of fetal loss in diabetic patients undergoing antepartum fetal evaluation in a case-control study.


METHODS
Fetal assessment (non-stress test and/or biophysical profile) logbooks from January 1981 to June 1998 were reviewed and the patients with diabetes were identified. The study group comprised patients with pregnancy loss. Each case was matched by year of delivery and class of diabetes with four randomly selected controls with no pregnancy loss. All patients in both groups were at > 26 weeks' gestation.


RESULTS
Thirteen stillbirths and four neonatal deaths occurred in 1,935 diabetic patients who underwent fetal evaluation. There was no significant difference in age, race, gravidity, parity, clinic or private service, or the type of delivery in the two groups. Losses were more likely (p < 0.001) to occur before 32 weeks, with birth weights < 2,500 g, with a greater time interval from their last fetal evaluation, with poor glycemic control and with congenital malformations (six of seven occurred before 1990). In this study, perinatal losses were associated with non-compliance and other associated problems in the mother. Overall perinatal mortality in these patients was 17 per 1935 and corrected 11 per 1935 or 5.6 per 1,000.


CONCLUSIONS
In the 1980s suboptimal glycemic control with major fetal malformations emerged as the major contributory factor to perinatal loss and, in the 1990s, this was associated medical problems. With a better awareness of the adverse effect of suboptimal glycemic control at the time of organogenesis and advances in fetal diagnosis and evaluation, fetal loss due to diabetes has become a rarity. Patients with associated medical problems and those at risk for abruptio placentae should be managed more aggressively.
Brecher
A
A
College of Physicians and Surgeons, Columbia University at New York Presbyterian Hospital, New York, New York, USA.
Tharakan
T
T
Williams
A
A
Baxi
L
L
D000328:Adult; D001724:Birth Weight; D001786:Blood Glucose / Q000378:metabolism; D016022:Case-Control Studies; D000013:Congenital Abnormalities / Q000453:epidemiology; D005260:Female; D005313:Fetal Death / Q000453:epidemiology*; D005323:Fetal Monitoring / Q000379:methods*; D005865:Gestational Age; D006441:Hemoglobin A / Q000378:metabolism; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000097:blood / Q000150:complications*; D011295:Prenatal Care; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
D001786:Blood Glucose; D006441:Hemoglobin A