[Early detection of diabetes in pregnancy--a factor for reducing perinatal mortality and morbidity].

At present the main problem in gestational diabetes (GDM) is that only less than 10% of the pregnant diabetics could be diagnosed and accordingly treated. Analysing 101 cases of pregnant diabetics we refer to the incidence of peripartal and perinatal complications. The treatment with insulin was necessary to be applied on 70 of the patients (69.3%) in order to achieve normal glucose levels (between 3.3 and 6.6 mmol/l). If the metabolic complications are determined and treated in a later phase of pregnancy, there is a higher rate of complications (toxemias 29.7%, premature labor 21.8%, caesarean section 23.8%, perinatal mortality 2.9%, congenital anomalies 5.9% and the likelihood of large for gestational age babies 32.7%). Improvement of such results, which can be obtained in optimally treated insulin - dependent pregnants, is possible only by more early determination of all carbohydrate tolerance disturbances in pregnancy. This proposed diabetic screening is generally required in any pregnant woman with a history diabetes, obesity greater than or equal to 20%, age greater than or equal to 30 years and glucosuria. A gestational diabetes is to be considered into consideration if in a 50 g-oral-glucose-tolerance-test (50 g - OGTT) 2 values exceed normal limits (fasting level 5.55 mmol/l, 60 minutes level 8.88 mmol/l and 120 minutes level 7.22 mmol/l). Further observation of these patients has to be continued centrally.