Pregnancy in women with diabetes mellitus. The beginning

Before the discovery of insulin in 1921, pregnancies in women with diabetes mellitus were uncommon. Most patients succumbed to ketoacidosis within 1 to 2 years after diagnosis. Insulin therapy restored the fertility of these women, and maternal deaths were nearly eliminated; however, the perinatal mortality rate remained high. Elective preterm deliveries were planned to reduce the stillbirth rate, often resulting in neonatal deaths from respiratory distress syndrome. Furthermore, women with more severe disease were able to become pregnant with a risk of complications due to preeclampsia.