Changing panorama of perinatal and infant mortality in diabetic pregnancy

In a 21-year study covering 1960 to 1980, perinatal and infant mortality in 237 infants of diabetic mothers were analysed. The study was divided into three 7-year periods related to changes in management. In period I (1960-66) the perinatal mortality was 24.3%, decreasing to 5.0% in period II (1967-73) and to 1.1% in period III (1974-80). The corresponding figures for infant mortality were 31.4%, 7.5% and 4.6% respectively. Today the difference between the perinatal mortality rate in diabetic vs. non-diabetic pregnancies is almost negligible. However, perinatal mortality may give a false impression of pregnancy outcome, since owing to the high rate of lethal malformations in period III, infant mortality was still twice that of the non-diabetic population. During the 21-year period studied, complications of diabetic pregnancies such as severity and duration according to the White classification, hypertension and pyelonephritis in pregnancy and preterm delivery all decreased. Consequently the influence of these complicating factors on the overall outcome of diabetic pregnancies has declined.