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Blood glucose control during pregnancy

J S Skyler, M J O'Sullivan, E G Robertson

    Diabetes Care
    |January 1, 1980
    PubMed
    Summary

    Intensive management of pregnant diabetic women improved pregnancy outcomes, with all infants surviving. Patient self-monitoring of blood glucose is key to achieving better glycemic control during pregnancy.

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    Area of Science:

    • Endocrinology
    • Obstetrics
    • Perinatology

    Background:

    • Diabetic control is crucial in pregnancy due to hyperglycemia's adverse effects on the fetus.
    • Pregnant women with diabetes require specialized management to optimize fetal and maternal outcomes.

    Purpose of the Study:

    • To evaluate the effectiveness of an intensive therapeutic program for insulin-dependent pregnant diabetic women.
    • To assess the impact of improved glycemic control on pregnancy outcomes in this high-risk population.

    Main Methods:

    • A cohort of 18 insulin-dependent pregnant diabetic women (White Class B-R) received intensive education, a multiple-component insulin regimen, dietary control, and activity balancing.
    • Patients monitored blood glucose 4-7 times daily using the Dextrostix/Eyetone system.

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  • Therapeutic goals included fasting glucose 60-90 mg/dl, preprandial <105 mg/dl, and postprandial <120 mg/dl, avoiding significant hypoglycemia.

    • Main Results:

    • The intensive program achieved target glycemic control for most of the monitoring period in the majority of patients, with marked improvement in others.
    • Despite challenges, all infants survived, showing improved outcomes compared to previous pregnancies (38% live offspring previously).
    • Neonatal morbidity included macrosomia (33%), significant hypoglycemia (11%), and congenital malformations (22%).

    Conclusions:

    • The intensive therapeutic approach, including patient self-monitoring of blood glucose, significantly improved pregnancy outcomes in insulin-dependent diabetic women.
    • While neonatal morbidity persists, the overall survival rate and health of infants represent a marked improvement.
    • Patient self-monitoring of blood glucose is a practical and effective tool for achieving glycemic control in pregnant diabetic patients.