TRANSIENT IMPROVEMENT IN GLYCEMIC CONTROL - THE IMPACT OF PREGNANCY IN WOMEN WITH IDDM

OBJECTIVE- Good glycemic control throughout pregnancy in patients with diabetes is of paramount importance but often appears to deteriorate in the postpartum period. The aim of this study was to ascertain the t iming of the improvement in glycemic control associated with pregnancy in women with IDDM and to examine changes in glycemic control after d elivery. RESEARCH DESIGN AND METHODS- Peripartum glycemic control was assessed in a retrospective study of 30 women with IDDM whose age was 28 +/- 6 years (means +/- SD) and whose diabetes duration was 14 +/- 6 years. RESULTS- Mean total HbA(1) fell incrementally from a peak at 2 -3 years preconception to a nadir between 24 weeks and term, only to r eturn to preconception levels within a year after delivery. Of the 30 women, 15 (50%) attained an HbA(1) in the nondiabetic range for pregna ncy at some point during their pregnancy, and 7 (23%) women achieved t his by 24 weeks gestation. Women with an HbA(1) >9% at booking had a s ignificantly higher HbA(1) at 0-6 and 6-12 months preconception, and t hroughout pregnancy their HbA(1) was significantly higher. After deliv ery attendance rates at routine diabetes review clinics were low, with 11% of women not attending for longer than 24 months. CONCLUSIONS- Ne arly all women with IDDM can achieve near normoglycemia during pregnan cy irrespective of previous glycemic control, although those with high HbA(1) levels at booking are less likely to achieve this. After deliv ery, glycemic control deteriorates. Efforts to improve glycemic contro l should be intensified in the preconception period and maintained aft er delivery. The poor postpartum attendance at diabetes clinics requir es specific action.