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[Obstetrical behaviour in diabetes. Perinatal mortality (author's transl)]
Medicina Clinica
|March 25, 1980
Summary
Managing diabetes during pregnancy significantly reduces high maternal-fetal mortality rates. A revised care protocol, including nocturnal carbohydrate supplements, led to a notable decrease in perinatal mortality for diabetic pregnancies.
Area of Science:
- Obstetrics and Gynecology
- Endocrinology
- Perinatology
Context:
- Diabetes in pregnancy presents significant risks for both mother and fetus.
- High rates of maternal-fetal mortality persist in diabetic pregnancies.
- This study analyzes outcomes from two distinct periods to evaluate changes in care protocols.
Purpose:
- To assess the impact of an updated clinical protocol on perinatal mortality in diabetic pregnancies.
- To identify specific interventions contributing to improved pregnancy outcomes.
- To evaluate the incidence of complications such as macrosomia, preterm birth, and urinary tract infections.
Summary:
- A cohort of 134 diabetic women (Types A, B, and C) was studied across two time frames (1972-1975 and 1976-1978).
- The revised protocol included nocturnal carbohydrate supplementation to prevent hypoglycemia, late-term admission (32-34 weeks), strict bed rest, and fetal maturity monitoring.
- Results showed a significant reduction in perinatal mortality, with no increase in macrosomia, preterm birth, or maternal urinary infections.
Impact:
- Implementation of a structured care protocol demonstrably reduces perinatal mortality in diabetic pregnancies.
- Specific interventions, like nocturnal carbohydrate supplementation, appear effective in mitigating risks.
- While hydramnios and toxemia remained elevated, the overall management strategy improved fetal outcomes, though Type C diabetes neonates showed higher depression rates at birth.