[Intensive care of insulin dependent diabetic pregnant women. Perinatal outcome in relation to gestational age at the initial visit].

BACKGROUND AND AIM

To correlate the perinatal outcome of insulin-dependent diabetic (IDDM) pregnant women with the quality of metabolic control defined as gestational age at initial visit, extent and duration.

MATERIALS AND METHODS

A total of 64 pregnant women classified from White's class B to class R were included in the study: 55 pregnant women joined the study before the 9th week (early control group), 9 after the 26th week (late control group). On the basis of perinatal outcome, the 55 pregnant women in the early control group were then subdivided into a further two groups: 34 patients with optimal outcome and 21 with non-optimal outcome.

RESULTS

In the early control group of pregnant women, overall mean daily glycemia was significantly lower in the group with optimal outcome compared to that with non-optimal outcome during the 1st and 2nd trimester, but not in the 3rd. Compared to the early control group, during the 3rd trimester patients in the late control group showed significantly higher levels of: overall mean daily glycemia, glycosylated hemoglobin and fructosamine. In the early control group maternal morbidity (p < 0.05), neonatal morbidity (p < 0.03) and perinatal mortality (p < 0.05) were significantly lower than in the late control group.

CONCLUSIONS

The achievement of optimal glycometabolic control in the 2nd trimester appears to be a prerequisite for improving maternal-fetal outcome in the early control group compared to that in the late control group in which the attainment of good glycemic control during the 3rd trimester does not seem to be efficacious in reducing overall morbidity and mortality.