How to improve prognosis in type 1 diabetic pregnancy. Old problems, new concepts.

OBJECTIVE

To improve the prognosis of pregnancy in type 1 diabetes.

RESEARCH DESIGN AND METHODS

This study is an epidemiological analysis of pregnancy outcome in type 1 diabetic mothers attending the combined diabetic antenatal clinic at the Royal Maternity Hospital, Belfast, from 1940 to 1990. Short-term measurement of maternal insulin sensitivity and of intrauterine fetal habituation was taken in selected pregnancies. The article also assesses the European and U.K. recommendations for diabetes in pregnancy, with a goal "to achieve pregnancy outcome in the diabetic woman that approximates that of the non-diabetic woman."

RESULTS

Outcomes from 1985 to 1995 in > 800 pregnancies, of which about 60% were delivered at the Regional Centre, suggested that the perinatal mortality was lower for those managed throughout at the center. The highest obstetric risk was in those pregnancies referred to the center at some point later in the pregnancy from a peripheral obstetric clinic. Studies of insulin sensitivity in normal and preeclamptic pregnancy by minimal-model analysis of a frequently sampled intravenous glucose tolerance test and of glycosylated hemoglobin in a large survey of nondiabetic pregnancy indicate that the pregnant state may unmask an increase in insulin resistance, causing both pregnancy-induced hyperglycemia and pregnancy-induced hypertension. Fetal habituation, studied by responses to a variable sound stimulus, was less effective in diabetic pregnancy, which may indicate changes in fetal brain function.

CONCLUSIONS

Pregnancy in a type 1 diabetic mother remains a high-risk obstetrical situation, even with presently available intensive diabetic supervision.