French multicentric survey of outcome of pregnancy in women with pregestational diabetes.
OBJECTIVE
To evaluate perinatal outcome in pregnancies in women with type 1 and type 2 diabetes and the influence of preconception care 10 years after the St. Vincent's declaration.


METHODS
A cross-sectional study was conducted in 12 perinatal centers in France in 2000-2001. The main investigated outcomes were perinatal mortality, major congenital malformations, and preterm delivery.


RESULTS
Among 435 single pregnancies, 289 (66.4%) were from women with type 1 and 146 (33.6%) from women with type 2 diabetes. Perinatal mortality rate was 4.4% (0.7% national rate), severe congenital malformations rate was 4.1% (2.2% national rate), and preterm delivery rate was 38.2% (4.7% national rate). Preconception care was provided in 48.5% women with type 1 diabetes and in 24.0% women with type 2 diabetes. Women whose first trimester HbA(1c) was >8% had higher rates of perinatal mortality (9.2 vs. 2.5%; odds ratio 3.9; 95% CI 1.5-9.7; P < 0.005), major congenital malformations (8.3 vs. 2.5%; 3.5; 1.3-8.9; P < 0.01), and preterm delivery (57.6 vs. 24.8%; 1.4; 1.1-1.7; P < 0.005) than those with first trimester HbA(1c) <8%. These results are similar to those reported in France in 1986-1988.


CONCLUSIONS
Pregnancies in women with diabetes are still poorly planned and complicated by higher rates of perinatal mortality and major congenital malformations. Despite knowledge of the importance of intensified glycemic control before pregnancy, reaching the St. Vincent's target needs further implementation in France.
Pierre
P
Boulot
Nathalie
N
Chabbert-Buffet
Claude
C
d'Ercole
Michele
M
Floriot
Pierre
P
Fontaine
Alain
A
Fournier
Jean Yves
JY
Gillet
Henri
H
Gin
Sylvie
S
Grandperret-Vauthier
Ann Marie
AM
Geudj
Brigette
B
Guionnet
Sylvie
S
Hauguel-de-Mouzon
Sylvie
S
Hieronimus
Mederic
M
Hoffet
Dominique
D
Jullien
Marie Françoise
MF
Lamotte
Veronique
V
Lejeune
Jacques
J
Lepercq
Françoise
F
Lorenzi
Pierre
P
Mares
Alain
A
Miton
Alfred
A
Penfornis
Brigitte
B
Pfister
Eric
E
Renard
Michel
M
Rodier
Philippe
P
Roth
Guy-Alain
GA
Sery
José
J
Timsit
Anne Sylvie
AS
Valat
Anne
A
Vambergue
Odile
O
Verier-Mine
D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011254:Pregnancy in Diabetics / Q000453:epidemiology*; D015995:Prevalence