Treatment of non insulin-dependent diabetic women during pregnancy

From 1981 to 1984 90 cases of diabetic pregnancy were seen at the Palermo Center. Twenty-nine patients (32%) had prepregnancy type 2 diabetes, 20 (69%) of these were obese and were studied further. The patients were divided into 2 groups of 13 and 7 patients. The first group was given a diet of 30 kcal/kg ideal prepregnancy weight. The second group was prescribed a low energy diet of on average 1200 kcal/day. In the diet-restricted group, weight gain was less pronounced (7.9 +/- 1.2 SD vs. 12.7 +/- 8.6 kg), insulin requirement was lower (0.56 +/- 0.22 vs. 1.00 +/- 0.34 U/kg body weight) and the metabolic control was better than observed in the group given 30 kcal/kg body weight. The weight gain during pregnancy was proportional to the fetal weight index at birth (r = 0.72, P less than 0.0005). It is concluded that obese type 2 diabetic women are best treated by a low caloric diet and, when necessary, small doses of insulin. To establish the optimal caloric intake for obese pregnant type 2 diabetic women, the following formula is proposed: (30 kcal/kg prepregnancy ideal body weight/24 h) - X, where X is the % of prepregnancy obesity exceeding 120.