Strict glycemic control in women with pregestational insulin-dependent diabetes mellitus

To determine the efficacy of strict glycemic control in women with pregestational insulin-dependent diabetes mellitus (IDDM).

The records of 62 pregnant women with pregestational IDDM who had attended the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Virgen de las Nieves General Hospital, Granada, Spain, between 1982 and 1992, were reviewed. The women had received several daily doses of a mixture of rapid action (regular) and intermediate action insulin with the aim of keeping preprandial glucose levels lower than 95 mg/dl and postprandial glucose levels lower than 120 mg/dl. Perinatal outcomes were compared with those of a control group consisting of 96 randomly selected, normal, pregnant women who gave birth at approximately the same time.

Mean glycemic profile in the first assay at an insulin dose of 33.1 +/- 15.9 IU/day was 153.7 +/- 52.3 mg/dl and the HbA1c was 7.7 +/- 2.3%. In the last assay before delivery patients received an insulin dose of 68.2 +/- 30.7 IU/day and had a mean glycemic profile of 94.4 +/- 18.1 mg/dl and an HbA1c of 5.9 +/- 1.4% (P < 0.001 for all parameters). The perinatal mortality of newborn infants of the diabetic mothers was 48 per 1000, and 11.3 per 1000 had some congenital malformations.

Our results verify that strict glycemic control decreases the elevated perinatal mortality normally suffered by IDDM patients. However, if it is to reduce the number of congenital malformations, it must be initiated before the early gestational stages.