Outcome of pregnancies complicated by pre-gestational diabetes mellitus

Pregestational diabetes mellitus (DM) is associated with adverse fetal and maternal outcomes. Studies suggest that optimal control of diabetes before and during pregnancy minimises these risks. There are few recent reviews of outcomes of pregnancies complicated by DM in Australia. Ninety-three pregnancies in women with DM at our hospital since 1989 were i dentified. We collected data for maternal age, type of diabetes, duration o f therapy, complications of diabetes, maternal complications of pregnancy a nd fetal outcomes including malformations. The rate of pregnancy planning w ith optimal glycaemic control at conception was low in our population, part icularly in patients with Type 1 diabetes. Women who smoked had worse glycaemic control, and a higher rate of miscarri age. There was a high rate of Caesarean section, particularly in those wome n with Type 1 diabetes (77.4%). The rate of Caesarean section was lower in planned pregnancies. There were no perinatal deaths. The number of neonates with major congenital anomalies was high (13%) in the Type 1 population. It is important to increase the rates of prepregnancy planning and to optim ise glycaemic control before pregnancy. In many cases there has been a long interval between diagnosis and pregnancy, so all women with diabetes shoul d receive counselling at frequent intervals about pregnancy and the importa nce of planning. Women who planned their pregnancies had improved outcomes, with decreased rate of Caesarean section, better glycaemic control and bet ter neonatal Apgar scores. Women with diabetes should not smoke during preg nancy because of the increased risk of miscarriage and poorer glycaemic con trol.