Diabetes prior to pregnancy: 143 cases

Objective - The authors want to appraise the management of diabetes prior t o pregnancy in a local population treated in the Lille University Hospital. Method - This is a retrospective study of 143 pregnancies occurring in 111 patients with diabetes prior to pregnancy, between 1987 and 1997, in the Ob stetrics Department at the Lille University Hospital. Results - Only one-third of the patients benefited from preconception manag ement; the stability of diabetes during the first trimester was satisfactor y in 50% of the cases. The maternal complications are represented by preecl ampsia (20%), metabolic complications specific to diabetes (hypoglycemia, k etoacidosis), the aggravation or the emergence of a retinopathy (10%) and p olyhydramnios (19%). Concerning the termination of the pregnancies, of the 147 fetuses (four twin pregnancies), 140 newborns in good health, two neona tal deaths, three in-utero deaths and two therapeutic terminations of pregn ancy were observed. The fetal malformation rate was 9.5% (14 cases/147). Th e cesarean section rate was 63%, whereas the fetal macrosomatia rate was 35 %, with dystocia in 26% of the deliveries (outside of planned cesareans). T hree shoulder dystocia were observed (two requiring the Jacquemier's maneuv er and one with transitory plexus brachial palsy for a newborn weighing 5,6 50 g). Conclusion - The authors conclude that preconception management (one-third of the patients in this series) and management during the first trimester o f pregnancy (50% in this series) was insufficient. This fact is perhaps due to the confusion, for many practicioners, with gestational diabetes, which is a very mediatized affection, though much less severe for the fetus and mother. (C) 1999 Editions scientifiques et medicales Elsevier SAS.