[Can education duning pregnancy improve the perinatal outcome in diabetic pregnancies?]

The aim of the study was to define the role of education for the complex treatment plan of diabetes during pregency and to estimate the impact of education for the reduction of the incidence of maternal and neonatal complications.

A retrospective study of 56 pregnant women with diabetes was carried out. They were hospitalized in the High-risk pregnancy Department from January 1999 till January 2000. All pregnant women were admitted to the hospital in each trimester of pregnancy for control of carbohydrate metabolism and follow-up of pregnancy. All pregnant women were treated by intensified Insulin regime-type basal-prandial. The diet was set according to the needs during pregnancy. 30 pregnant women (group 1) were educated according to the specificity of diabetes during pregnancy. The education was repeated every time the patient was admitted to the hospital. The aim of education was to reach and maintain good metabolic control (HbA1c < 7.5%) in the course of pregnancy. The values of HbA1c before education in group 1 and after final education in group 2 (not educated) were determinated. The incidence of some maternal and perinatal complication-the progress from diabetic nonproliferative retinopathy into proliferative retinopathy, the development of preeclampsia as a causative factor for delivery before 37 g.w, the development of RDS and perinatal deaths were evaluated.

There was a significant difference in the mean values of glycosylated Hb. In the group of educated women a good metabolic control was achieved--HbA1c = 7.5%. In the non-educated group the metabolic control was poor--HbA1c = 8.4%, irrespective of the insulin and diet treatment. 25 (84.4%) of the babies born to educated mothers had normal birthweight between 3000 and 4000 grams. 2 (6.6%) of the newborn had birthweight under 3000 gr. and 3 (10%) over 4000 gr. In the group of educated women there was no progress of nonproliferative retinopathy into proliferative type. There was such a progression in 3 women from the noneducated group. There were 22 cases of preeclampsia in both groups. In the group of educated women the preeclampsia was mild, compared to the noneducated group where the form was severe. All women with severe form of preeclampsia (n=8) delivered before 37g. w. There were no perinathal deaths in the educated group, compared to 3 (11.5%) deaths in group 2. 2 babies died antenatally and one after an operative correction for severe congenital heart defect. There were 6 (6.6%) cases of RDS from the educated group compared to 99 (16.6%) from group 2.

The education is a key factor in the complex plan of treatment of pregnant women with diabetes. It creates a positive motivation for the achievement and maintenance of good metabolic control during pregnancy. The incidence of maternal and neonatal complications is higher in the group of non-educated women. The education significantly reduces the incidence of maternal and neonatal complications, thus improving the perinatal outcome.