OBJECTIVE -The aim of this study was to compare pregnancy outcomes in type 1 diabetic pregnancies with the background population.RESEARCH DESIGN AND METHODS -This nationwide prospective multicenter study took place in eight Danish centers treating pregnant women with type 1 diabetes during [1993][1994][1995][1996][1997][1998][1999]. A total of 990 women with 1,218 pregnancies and delivery after 24 weeks (n ϭ 1,215) or early termination due to severe congenital malformations (n ϭ 3) were included. Data were collected prospectively by one to three caregivers in each center and reported to a central registry.RESULTS -The perinatal mortality rate was 3.1% in type 1 diabetic pregnancies compared with 0.75% in the background population (RR 4.1 [95% CI 2.9 -5.6]), and the stillbirth rate was 2.1% compared with 0. 45 (4.7 [3.2-7.0]). The congenital malformation rate was 5.0% in the study population and 2.8% (1.7 [1.3-2.2]) in the background population. Six of the perinatal deaths (16%) were related to congenital malformations. Only 34% of women performed daily home monitoring of blood glucose at conception, and 58% received preconceptional guidance. Pregnancies with serious adverse outcomes (perinatal death and/or congenital malformations) were characterized by higher HbA 1c values before and during pregnancy and a lesser degree of maternal self-care and preconceptional guidance. Women who performed daily self-monitoring of blood glucose at any time during pregnancy had lower HbA 1c values than women who did not measure their daily profile. Likewise, daily self-monitoring was associated with a reduction in serious adverse outcomes. The caesarean section rate was 55.9 and 12.6%, respectively, and the risk of preterm delivery was 41.7 and 6.0%, respectively. CONCLUSIONS -Type 1 diabetic pregnancies are still complicated by considerably higher rates of severe perinatal complications compared with the background population, and women with poor self-care are at the highest risk. Adequate glycemic control using daily glucose monitoring before and during pregnancy is a crucial step toward reaching the goals of the St. Vincent declaration. Diabetes Care 27:2819 -2823, 2004I n 1989, the St. Vincent declaration (1) stated that the outcome of diabetic pregnancy should approximate that of the nondiabetic pregnancy within 5 years. Since then, four regional prospective studies from the U.K. and Finland (2-5) and two nationwide studies from Holland and France (6,7) have reported rates for perinatal mortality and/or congenital malformations, considerably higher than the background population. The number of pregnancies varied from 111 to 691. In Denmark, clinical data have been prospectively collected since 1992, which enables us to analyze data on a cohort of Ͼ1,200 consecutive pregnancies. The objective was to compare pregnancy outcomes in type 1 diabetic pregnancies with the background population. -During 1993-During -1999, all pregnancies in women with pregestational type 1 diabetes were prospectively reported to a central registry...

OBJECTIVETo study the association between peri-conceptional A1C and serious adverse pregnancy outcome (congenital malformations and perinatal mortality).RESEARCH DESIGN AND METHODSProspective data were collected in 933 singleton pregnancies complicated by type 1 diabetes.RESULTSThe risk of serious adverse outcome at different A1C levels was compared with the background population. The risk was significantly higher when peri-conceptional A1C exceeded 6.9%, and the risk tended to increase gradually with increasing A1C. Women with A1C exceeding 10.4% had a very high risk of 16%. Congenital malformation rate increased significantly at A1C above 10.4%, whereas perinatal mortality was increased even at A1C below 6.9%.CONCLUSIONSThese results support recent guidelines of preconceptional A1C levels <7% in women with type 1 diabetes.

Several studies have suggested that the risk of perinatal death and/or congenital malformations is substantially more common in women with type 1 diabetes than in a background population. This nationwide, prospective, multicenter study was carried out in 8 Danish centers in the years 1993-1999. The study population included 990 women with pregestational type 1 diabetes who had a total of 1218 pregnancies and who, with 3 exceptions (early terminations because of severe congenital malformations), delivered after 24 weeks gestation. Perinatal mortality was defined as stillbirth after 24 weeks gestation or death in the first week of life. The subjects did not differ from the background population of 70,089 deliveries with respect to age or body mass index. Patients had been diabetic for a mean time of 12 years. Approximately one third of women monitored their blood glucose daily at the time of admission; by the third trimester, the figure had risen to 65%. Nearly 60% of women received guidance preconceptionally.Perinatal mortality was 3.1% in type 1 diabetic pregnancies, compared with 0.75% in the background population. The respective rates of stillbirth were 2.1% and 0.45%. Congenital malformations were detected in 5% of the study group and in 2.8% of control women. Six perinatal deaths (16%) were related to malformations. Pregnancies with serious adverse outcomes (perinatal death and/or congenital malformations) were associated with higher HbA 1c values before and during pregnancy, and with less frequent maternal self-care and preconceptional guidance. Women who monitored their blood glucose everyday had relatively low HbA 1c levels at all stages of pregnancy. When women monitored their blood glucose everyday, serious adverse outcomes were less frequent. The respective figures for these women and for those who did not monitor their blood glucose regularly were 4.6% versus 7.6% preconceptionally, 5.3% versus 8.3% in the first trimester, 5.7% versus 8.3% in the second trimester, and 5.3% versus 8.1% in the third trimester. Cesarean section was carried out in 55.9% of diabetic women and 12.6% of controls. The respective rates of preterm delivery were 41.7% and 6.0%.These findings indicate that adequate control of blood glucose by daily monitoring can improve pregnancy outcomes for women with type 1 diabetes. Women who neglect self-care are at the highest risk of an adverse outcome.