Patient cooperation: a determinant of perinatal outcome in the pregnant diabetic.

From 1974 through 1978, 59 insulin-dependent diabetic patients were treated in a university-affiliated general hospital. They were managed primarily as outpatients with hospitalization for regaining glucose control and/or in the treatment of obstetric complications. In 1976 a special clinic for pregnant diabetic patients was established. The 26 patients treated during the clinic's first two years are compared to 33 treated in the preceding 2 1/2 years. The significant difference between the two groups was the improvement in the number of patients whose cooperation was good, 67% to 85% (p less than 0.05), and the reduction of perinatal morbidity and mortality. The perinatal mortality rate was 18% and 8% in the preclinic group (group I) and the clinic group (group II), respectively. The combined perinatal morbidity and mortality was reduced from 36% to 15%, respectively, in groups I and II (p less than 0.01). A constant rate of 3.2% perinatal mortality was observed in the obstetric population during the study period.