PREGNANCY OUTCOMES IN MOTHERS WITH PREGESTATIONAL DIABETES - A POPULATION-BASED STUDY IN NORTH RHINE (GERMANY) FROM 1988 TO 1993

The purpose of this study was to estimate the proportion of pregnancie s with pregestational diabetes in Germany, to compare the outcome of t hese pregnancies to pregnancies in nondiabetic mothers and to identify risk factors for poor pregnancy outcomes in mothers with pregestation al diabetes. Data of the ''Perinatalerhebung Nordrhine'' from 1988-199 3 were analysed. The Perinatalerhebung is an ongoing quality assurance programme of prenatal and perinatal care in the region of North Rhine (South Western part of North Rhine-Westphalia). During the observatio n period a proportion of 93%-100% of the annual births in the region ( n = similar to 100000) were included in the study. Their data had been documented by the obstetricians in a standard multiple choice questio nnaire. The outcome parameters perinatal mortality, macrosomia, premat urity, and malformations were analysed in relation to several defined explanatory variables. There were 2,402 births in mothers with pregest ational diabetes (0.4% of all births). The proportions of poor pregnan cy outcomes in women with pregestational diabetes were 2.8% for perina tal mortality, 27.6% for macrosomia, 21.1% for prematurity and 2.1% fo r malformations. The respective relative risks compared to the non dia betic mothers were 4.3 (95% CI 3.4-5.5) for perinatal mortality, 3.1 ( 95% CI 2.9-3.3) for macrosomia, 2.7 (95% CI 2.5-2.9) for prematurity a nd 1.7 (95% CI 1.3-2.3) for malformations. The main risk factor for pe rinatal mortality in children of diabetic mothers after adjustment for maternal smoking, ethnicity, parents' professional achievement, type of obstetric hospital, and maternal age was substandard use of prenata l care. Conclusions The prevalence of births from mothers with pregest ational diabetes and their pregnancy outcomes were similar to those in other Western countries. The standard for non-diabetic mothers has no t been reached yet. Further improvements may be achieved if all diabet ic women are convinced to use the standard prenatal care facilities th roughout pregnancy.