Intrapartum performance of patients presenting with diabetes mellitus in pregnancy.

OBJECTIVE

To investigate the intrapartum performance of pregnancies complicated by diabetes mellitus (DM).

SUBJECTS AND METHODS

A pilot study (April-June 2005) of medical records of patients with DM admitted into the labour wards of the Maternity Hospital, Kuwait, was undertaken. Consecutive patients, matched for age and parity with the study group and with no medical complications, admitted for induction of labour during the study period served as the control. The ethnicity, obstetric/medical history and antenatal course of the index pregnancy were extracted. The intrapartum, postpartum and the neonatal outcome were documented. Statistical analysis was performed using chi(2) and alternative Welch t tests.

RESULTS

During the study period, 3,005 patients were delivered at the hospital, and 177 of these (the study population) presented with DM, an incidence of 5.9%. Another 177 patients admitted for induction of labour served as the control. Of the 177 study patients, 86 (48.6%) were Kuwaitis, and the remaining 91 (51.4%) were non-Kuwaitis, of whom 41 were Arabs (23.2%), 34 Indians (19.2%), and 16 Asians (9%). Of the controls, 65 (36.7%) and 112 (63.3%) were Kuwaitis and non-Kuwaitis, respectively. Of the 177 study patients, 128 (72.3%) presented with gestational DM. The significant complications were pregnancy-induced hypertension (13, 7.3%) and premature rupture of membranes (14, 7.9%). The incidence of caesarean section in the study population (58, 32.8%) was significantly higher than that of the controls (35, 19.8%; p = 0.008). Although the mean gestational ages at delivery in both groups were comparable (p = 0.669), the mean birth weight in the study group was significantly higher, 3.315 +/- 0.605 vs. 3.160 +/- 0.594 kg (p = 0.012). The neonatal complications in the diabetic patients were shoulder dystocia (4, 2.3%) and Erb's palsy (12, 1.1%); there were more perinatal deaths (3) in the control group.

CONCLUSION

The incidence of DM was high, and the rate of caesarean section significant. The maternal and neonatal morbidity were high. A prospective study is recommended for enhanced management guidelines.