Patient experience in a diabetic program project improves subsequent pregnancy outcome

Article Abstract:

The outcomes of pregnancies of insulin-dependent diabetic patients have improved thanks to intensive health care programs and increased awareness of patients and health care providers of the need for specialized prenatal care. To test the hypothesis that controlling blood sugar levels early on would also improve the outcome of pregnancy, a specialized program aimed at controlling blood glucose levels was assessed. The study involved 55 insulin-diabetic patients, who began participation in the specialized program before the ninth week of pregnancy in two consecutive pregnancies, referred to as sequence 1 and 2. Another group of 55 insulin-dependent diabetic patients of similar age to those in the sequence 2 pregnancies was used for control. Within the program participant group, blood glucose control improved from sequence 1 to sequence 2, and was associated with decreased levels of glycohemoglobin, or glucose-bound hemoglobin, which is the oxygen carrying pigment of red blood cells, at weeks nine and 14 during pregnancy. An improvement was also associated with earlier entry into the specialized program in the second pregnancy, and decreased rates of miscarriage and major malformations. The program participants also had an earlier week of entry into the program and better glycohemoglobin levels as compared with the control group. Seventy-three percent of program participants entered the program early in the sequence 2 pregnancy and had lower glycohemoglobin levels at nine weeks as compared with their sequence 1 pregnancy. Advanced diabetic disease was present in 65 percent of patients in sequence 2, 46 percent of patients in sequence 1, and 44 percent of control patients. These results show that achieving blood glucose control early in pregnancy improved outcomes of subsequent pregnancies regardless of progressive diabetic disease. Thus, diabetic patients can benefit from education provided by a perinatal center specializing in diabetic pregnancies. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Prognosis, Patient education, Blood sugar monitoring, Blood glucose test

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Spontaneous abortions in repeat diabetic pregnancies: a relationship with glycemic control

Article Abstract:

Women with insulin-dependent diabetes mellitus have a rate of spontaneous abortion (miscarriage) twice as high as the general population. This miscarriage rate may be associated with poor metabolic control in early pregnancy. The effects of better glycemic control (of blood sugar) in the second of two pregnancies were examined in a group of 43 diabetic women who became pregnant twice within the six-year study period. The patients took intermediate-acting insulin injections once each day and regulated their diet and exercise, prior to pregnancy; after they became pregnant, they received both short- and intermediate-acting insulin and dietary regulation. Patients were seen at least every two weeks in the clinic, and records of home glucose monitoring were reviewed. They were advised of the importance of glycemic control for preventing fetal malformation and miscarriage. The results showed that 20 women had 2 successful pregnancies; 15 had an unsuccessful pregnancy (miscarriage) followed by a successful pregnancy; 5 had a successful pregnancy followed by an unsuccessful one; and 3 had two unsuccessful pregnancies. When they became pregnant the second time, the women entered the clinic study at an earlier gestational stage (approximately one week earlier) than for the first pregnancy, allowing intervention sooner. The rate of miscarriage decreased significantly for these women. The findings indicate that glycemic control is important in preventing miscarriage in diabetic women. Patient education is an important component of any program to improve glycemic control in pregnant diabetic women, and, possibly, in all diabetics. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Miscarriage

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Hypertension during pregnancy in insulin-dependent diabetic women

Article Abstract:

Early studies concluded that women suffering from insulin-dependent diabetes were at a higher risk for developing pregnancy-induced hypertension (PIH) than were other women. They also suggested that when PIH occurred in these women, they were at an increased risk for death or complications. More recent studies have challenged this viewpoint. Many factors are involved in the development of PIH, which may account for the conflicting findings. This study examined the incidence of PIH in insulin-dependent diabetic women in relation to perinatal morbidity (disease rate) and mortality (death rate). The pregnancies of 175 women with insulin-dependent diabetes were monitored. Twenty-one patients had hypertension prior to pregnancy. PIH occurred in 15.4 percent of the women, including 4 of the 21 women that already had hypertension. This compared with a rate of 5.6 percent for the normal (nondiabetic) pregnant population at the same hospital during the same period. Compared with women who did not develop PIH, those who did were more likely to have not previously given birth, to have had poorer control of their diabetes in the first six months of pregnancy, and to have had more serious cases of diabetes. Infant morbidity and mortality rates were not different between the two groups. These results indicate that poor control of diabetes during pregnancy increases the risk for PIH and improved control may help prevent this problem. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hypertension, Causes of, Type 1 diabetes

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