Diabetes mellitus and pregnancy: management and results

A protocol for the diagnosis and management of diabetes mellitus in pregnancy is outlined. It entails frequent prenatal visits, strict metabolic control, a program for antepartum fetal surveillance using estriols and contraction stress testing, liberal hospitalization, fetal lung maturity assessment, individualization of the time of induction of labor and careful intrapartum fetal monitoring. The results of such a protocol over a two-and-a-half-year period involving 84 gestational (GD) and 23 insulin-dependent (IDD) diabetic pregnant women is described. The incidence of preterm labor (less than 37 weeks) was 7.1% in GD and 39% in IDD. The cesarean section rate was 15.4% in GD and 56.5% in IDD. The incidence of macrosomia was 20% in GD and 13% in IDD. There was one antepartum stillbirth in GD due to a true knot of the cord, and there were no neonatal deaths in either group, for a perinatal mortality rate of less than 1%. Neonatal morbidity was also decreased. Respiratory distress syndrome occurred in only one neonate of an IDD. The success of such a protocol in decreasing perinatal morbidity and mortality justifies the effort and cost expended.