Management of diabetes mellitus and pregnancy: a survey of obstetricians and maternal-fetal specialists

Article Abstract:

Agreement is not universal among physicians regarding the best way to treat pregnant women with diabetes mellitus (a form of diabetes characterized by high levels of blood sugar, sugar in the urine, and insufficient insulin). The condition can either arise as a consequence of pregnancy (gestational diabetes mellitus) or can be present prior to pregnancy and require insulin therapy (insulin-dependent diabetes mellitus, IDDM). To evaluate the variability in physicians' approaches to treating pregnant diabetic patients, questionnaires were sent to all members of the Society of Perinatal Obstetricians (SPO, 356 members) and to a random sample of Fellows of the American College of Obstetricians and Gynecologists (ACOG, 504). Questions concerned aspects of the physician's training, the management of and screening for gestational diabetes mellitus, and the care of patients with IDDM. ACOG respondents were divided two groups: in practice less than 15 years (ACOGa), and 15 years or more (ACOGb). Maternal-fetal medicine became a subspecialty about 15 years ago. Thirty-nine percent of ACOG Fellows and 77 percent of SPO members responded. Significant differences were noted between ACOGa and ACOGb physicians in how they treated patients with diabetes mellitus. No difference in patient care correlated with the time in practice for SPO members. Almost 90 percent of the SPO respondents always screen for gestational diabetes mellitus, while this was reported by 77.4 percent of ACOGa and 76.1 percent of ACOGb practitioners. This practice is at variance with ACOG recommendations, which suggest screening women 30 years and older. Both SPO and ACOGa respondents used a screening test consisting of a large volume of oral glucose, followed by a blood glucose test one hour later. Fewer ACOGb respondents used this method. The frequency of surveillance of the pregnant women differed among the groups, as did the use of insulin for gestational diabetes mellitus: almost 60 percent of maternal-fetal specialists used insulin for a large number of patients, while a much smaller proportion of ACOG members used this approach. Other major differences in treatment approaches were noted among the physicians surveyed. An extensive discussion is provided of diabetes in pregnancy: with proper treatment, the outcome of pregnancy for diabetic women need be no different from that for nondiabetics. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Prognosis, Surveys, Diabetes in pregnancy, Gestational diabetes, Obstetricians

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Duration of incarceration and perinatal outcome

Article Abstract:

A dramatic increase in the number of women prisoners in the last decade has resulted in an increase in the number of pregnancies and deliveries among incarcerated women. Studies have indicated that pregnancy outcomes are poorer among incarcerated women, but results are inconclusive. To learn more about the matter, a comparative study was carried out of the perinatal outcomes for women imprisoned for different durations. The short-term incarceration group consisted of 53 women imprisoned in Ohio for more than 1 week but fewer than 90 days; the long-term group consisted of 53 women imprisoned longer than 120 days. The two groups were matched for age, race, and number of previous live births. Information was collected concerning prenatal care (provided at prison infirmaries and the Ohio State University Hospital antepartum clinic), inmates' demographic characteristics, and pregnancy outcomes. Ten percent of the inmates were 19 or 20 years old and 60 percent were between 21 and 29 years; 80 percent had at least one other child. Poor prenatal care was documented for 53 percent of the short-term and 19 percent of the long-term prisoners. Smoking at least 20 cigarettes per day was common for 60 percent of the short-term and 64 percent of the long-term inmates; 57 percent and 36 percent of these women, respectively, had histories of substance abuse. Of babies born to short-term inmates, 32 (60 percent) were normal; 4 (7 percent) were stillborn; 8 (15 percent) were premature; 6 (11 percent) were small for gestational age; and 4 (7 percent) had clinical signs of sepsis (bloodborne infections). Eighteen babies were admitted to the neonatal intensive care unit (NICU). Forty-eight infants (91 percent) in the long-term group were normal; 2 were born to diabetic mothers; and 3 were premature. The latter five were admitted to the NICU. For all inmates, longer periods of incarceration were associated with better outcomes. This finding should be considered by judges who often believe that the unborn child is protected by shorter sentences. It appears that access to prenatal care is enhanced for this population by imprisonment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Social aspects, Pregnant women, Prenatal care, Women prisoners

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Controlled trial of a preterm labor detection program: efficacy and costs

Article Abstract:

The effects of a program to prevent preterm (premature) births offered at a hospital primarily serving black, indigent women in Philadelphia, Pennsylvania are evaluated. Black women who were at least 18 weeks pregnant and at high risk for premature birth were assigned randomly either to attend a Preterm Labor Detection Clinic (198 women) or to undergo standard treatment in the high-risk clinic (high-risk controls, 178). Another group of women, judged to be at low risk for premature birth, were classified as low-risk controls (567). Patients in the Preterm Labor Detection Clinic were examined frequently by physicians and educated regarding the signs of preterm labor. The costs for all patients in the study were estimated. Results showed no differences between the two high-risk groups with respect to age, childbirth history, previous abortions, or related factors. In addition, the infants' average birth weight and gestational age were similar. No difference was found between the high-risk groups in the rate of preterm birth. The failure to find any effect from this extensive prenatal intervention is difficult to explain; compliance with the Preterm Labor Detection Clinic appeared satisfactory. Costs for this group were higher than for the other groups, an anticipated outcome because intervention was more frequent. It is concluded that the causes of preterm birth are complex, and involve a host of medical and sociodemographic factors. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Diagnosis, Women, Prevention, Causes of, Premature labor, Health education, African American women, Health education of women

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