Pregnancy outcomes among women with and with out diabetic microvascular disease (White's classes B to FR) versus non-diabetic controls

The objective of this paper is to evaluate the impact of contemporary manag ement on the maternal and neonatal outcomes of pregnancies complicated by d iabetes in women with microvascular disease versus women without microvascu lar disease. The study population consisted of two hundred and eighty-eight (288) pregnant women with pregestational diabetes and one hundred and fift y (150) healthy pregnant controls. Diabetic women were grouped according to the presence (n = 103) or absence of diabetic microvascular disease (n = 1 85). Data were collected regarding diabetes management, level of glycemic c ontrol, and the development of antenatal complications. Maternal and neonat al outcomes were compared among the three groups. Women in the diabetes gro ups were stratified according to mean blood glucose levels and glycosylated hemoglobin during each trimester. There was no significant difference foun d between the two diabetes groups in terms of preterm labor, polyhydramnios , pyelonephritis, and growth restriction. The only maternal complications t hat occurred with increased incidence among women with microvascular diseas e were acute hypertensive complications (51.6 vs. 32.9%; p < 0.05). However , when the diabetes groups were compared to healthy controls, a significant difference was seen in all maternal and neonatal complications. Preterm de livery, polyhydramnios, and large-for-gestational-age (LGA) infants were as sociated with poor third-trimester metabolic control as compared with other s in satisfactory metabolic controls: 30.8 vs. 11.4% for preterm delivery; 17.3 vs. 5.1% for polyhydramnios; 51.9 vs. 33.9% for LGA; p < 0.05. Congeni tal malformations were associated with poor first-trimester glucose control (5.8 vs. 1.3% anomalies in well-controlled women). Furthermore, major cong enital malformations were also significantly increased in the offspring of women with diabetic microvascular disease 6.8%, as compared to 1.69% in dia betic women without microvascular disease; p <0.01. The incidence of hypert ensive complications did not differ between the two diabetic groups. Preges tational diabetic women with and without microvascular disease can be couns eled to anticipate comparably favorable pregnancy outcomes, although matern al and neonatal complications may exceed that experienced by pregnant women without diabetes mellitus.