Diabetic pregnancy 1977-1990: have we reached a plateau?

We have compared 81 pregnancies in women with type 1 (insulin dependent) diabetes in 1984-1990 with 58 in 1977-1983. In 1984-1990, women booked earlier (8 weeks [median] vs 12 weeks), mean haemoglobin A1 was lower in each trimester, and fewer days were spent in hospital before delivery (5.3 days [mean] vs 15). The latter was due to more experience in managing diabetic control as outpatients and fewer admissions for fetal monitoring. Most admissions are now for pre-eclampsia and intercurrent illnesses. The proportion of deliveries by caesarean section has not changed significantly (53% in 1984-1990 vs 66% in 1977-1983), but most are now done as emergencies. The incidence of macrosomia is constant (26% in 1984-1990 vs 21% in 1977-1983). There was one stillbirth, one intra-uterine death (complicating maternal ketoacidosis) and one perinatal death in 1984-1990, compared with no losses in 1977-1983. Two babies had major congenital abnormalities in 1984-1990, compared with one in 1977-1983. These results compare favourably with those from other centres in the United Kingdom. We conclude we have reached a nearly irreducible minimum for hospital days before delivery and congenital abnormalities, but that there is scope for a small reduction in the caesarean section rate.