The effect of established and gestational diabetes on pregnancy outcome

Article Abstract:

One study reported that fetal death was nine times more common in pregnancies of women who had established, pre-existing diabetes than in nondiabetics. However, the significance of abnormal glucose tolerance detected during pregnancy, an indicator of gestational diabetes, is unclear. The consequences of different types of diabetes and glucose control on pregnancy outcome were studied in 731 Kuwaiti women. Five hundred and seventy cases of diabetes were discovered during pregnancy: 246 were identified as gestational diabetes while 324 were termed impaired glucose tolerance, a milder condition. The other 161 women had established diabetes. Half of all cases were treated with insulin. The perinatal death rate was significantly higher among diabetics due to more stillbirths in both established diabetics and gestational diabetics. Patients with impaired glucose tolerance had no such increase in stillbirths. Overall, the diabetic patients had heavier babies than a group of nondiabetic controls, but this increase in infant size was less apparent in the group with impaired glucose tolerance. Although women who are found to have impaired glucose tolerance during pregnancy appear to have an increased risk of higher birthweight without an increased risk of fetal death, this condition signals a risk for developing diabetes later in life and should be treated with dietary intervention at this early stage. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Diabetes in pregnancy, Gestational diabetes, Perinatal death, Kuwait

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Mode of delivery and neonatal death in 17,587 infants presenting by the breech

Article Abstract:

Under normal conditions, the fetus is positioned with its head positioned downward, or toward the birth canal. The abnormal positioning of the fetus with its buttocks closest to the birth canal is referred to as a breech presentation. In addition to complications associated with delivery, fetuses in the breech position have a greater incidence of structural and functional damage, compared with fetuses in the normal head down position. Furthermore, infants in the breech position who are born vaginally tend to have lower birth weights, compared with fetuses in the breech position delivered by cesarean section. The effects of cesarean birth on the mortality of infants presenting by the breech were assessed. Among 17,587 infants who presented in the breech position and weighed 500 grams (1.1 pounds) or more, 6,178 were delivered vaginally and 11,409 were delivered by cesarean section. The risk of death was greater for breech infants born vaginally than for those delivered by cesarean section among infants weighing 501 to 1,750 grams (about 1.1 to 3.8 pounds) at birth and among infants weighing over 3,000 grams (6.6 pounds) at birth. These findings suggest that cesarean section is associated with decreased mortality among breech infants. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Patient outcomes, Mortality, Infants (Newborn), Newborn infants, Cesarean section, Breech delivery, Breech birth

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• Abstracts: Factors influencing neonatal morbidity in gestational diabetic pregnancy. Cytogenetic findings in 1250 chorionic villus samples obtained in the first trimester with clinical follow-up of the first 1000 pregnancies

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