Outcome of pregnancy in diabetic women in Soweto, South Africa 1983-1992.

A specialized service for pregnant diabetic women of African ethnic origin from Soweto was introduced in May 1983 at Baragwanath Hospital. Modern methods of management were used, including home blood glucose monitoring. A total of 354 pregnancies (147 gestational, 207 pregestational) were managed over an 8 1/2 year period. All but 12 women were treated with insulin. Mean capillary blood glucose (+/- SD) ranged from 5.8 +/- 0.8 mmol l-1 in the insulin-dependent group to 6.2 mmol l-1 in the gestational group (p < 0.01). Although maternal hypoglycaemia was common (14.4%) in the insulin-dependent patients, no ill effects were noted. The highest Caesarean section rate was in the gestational group (56%), the lowest in the insulin-dependent group (39.8%) (p < 0.01). Mean (+/- SD) neonatal weights were similar in the insulin-dependent and non-insulin-dependent groups (3131 +/- 627.9 g and 3236 +/- 674.3 g resp. p = NS); offspring of the gestational group were heavier than the insulin-dependent group (3384.4 +/- 657.5 g) (p < 0.01). Neonatal hypoglycaemia occurred in less than 5% of offspring overall. The combined perinatal mortality was 6.1%, stillbirths accounting for the majority (63.6%) of deaths. Major congenital abnormalities occurred in 6(1.7%) of the offspring. The perinatal mortality of the 'control' group of 146 women was 26.1%. Glucose intolerance persisted in at least 34.7% of gestational diabetic women postpartum. This study suggests that a specialized service for pregnant diabetic women from a Third World community can be implemented with good effect and limited expense. Late presentation of pregestational diabetic women is a problem.