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.