Obstetric and diabetic care for pregnancy in diabetic women: 10 years outcome analysis, 1985-1995

Aim Ten-year outcome analysis of all pregnancies in diabetic women in a pop ulation of 1.5 million people. Methods Ascertainment of patients through the regional obstetrical computer , and by direct contact with each obstetrical unit. Retrospective assessmen t of early miscarriage of pregnancy from hospital records. Data are present ed for the six smallest obstetrical units, the four smaller district hospit als, two larger teaching hospitals and for the regional referral centre. Results Nine hundred and eighty-six fetal outcomes were identified, 753 in mothers treated with insulin before the pregnancy, 131 in mothers in whom i nsulin was started for the first time during the pregnancy and 102 in mothe rs treated by diet only. Overall perinatal mortality rates were 35.8 per 10 00 for those mothers booked and delivered at a local maternity unit, 28.9 p er 1000 for those booked and delivered at the regional centre, but 75.0 per 1000 for those who had booked locally but were transferred to the centre m idpregnancy. Information on blood glucose control before and during pregnan cy was relatively poorly documented. For the available data at the regional centre, only 160 of the 416 mothers had an identifiable preconception HbA( 1c) measurement (mean 7.9%, range 3.3-16.8%); at booking 360 of these mothe rs had a mean HbA(1c) of 7.5% and by the third trimester mean HbA(1c) was 6 .3% (range 3.3-13.2%). Conclusions The outcome of pregnancy in a diabetic mother in Northern Irela nd remains a higher risk than for the general population. There is evidence that results in the regional centre are better, but problems arise when tr ansfers occur mid-pregnancy. Measurement and recording of blood glucose con trol at all stages before and during pregnancy is incomplete.