Diabetic pregnancy in over 35 years old women

87 pregnancies in diabetic women older than 35 years at time of conception were studied. 3% were insulin-dependent diabetes mellitus (IDDM), 52% non insulin-dependent diabetes mellitus (NIDDM) and 45% gestational diabetes mellitus (GDM). Mean age was 38 +/- 3 years; BMI was 33.2 +/- 7.0 kg/m2; gestation rate was 5 +/- 3 and number of alive children was 2 +/- 2. Only 3% of pregnancies were planned. Mean time of reference to diabetic care unit was 17 +/- 10 weeks. 95% of the women required human insulin. Mean total daily insulin dose was 0.49 +/- 0.28 UI/kg/d, increasing with gestational age. Mean fasting glycemia was 6.85 +/- 1.93 mmol/l and mean post-prandial glycemia was 8.29 +/- 2.52 mmol/l. Mean time of delivery was 38 +/- 2.1 weeks (less than 37 weeks in 9%). Cesarean section was performed in 44% of 34 cases. Death in utero occurred in 11% of 54 cases, postnatal death in 4%, congenital malformations in 4%, macrosomia in 40%. 9% of infants received intensive neonatal care. No difference was found between NIDDM and GDM about outcome of pregnancy. These results underlined importance of early screening for GDM as most cases seem to be undiagnosed pregravid diabetes mellitus (DM).