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Sixty-one pregnant patients with insulin-dependent diabetes mellitus completed a self-monitoring program consisting of five daily blood glucose tests at least twice weekly during the ambulatory periods of their pregnancies. Either a reflectometer method, Eyetone, glucometer--reflectometer, or Haemoglucotest 1-44 test strips were used. Of 1 834 glucose profiles, 45% were optimal, with all blood glucose values between 3.9 and 8.3 mmol/l. The 61 pregnancies were compared with 62 pregnancies where the diabetic control and therapy principles were identical, but where self-monitoring blood glucose methods were not employed. The self-monitoring regime resulted in a significant drop in mean blood glucose levels, from 7.8 +/- 1.3 to 6.4 +/- 1.0 mmol/l, compared with the period before the self-monitoring program was introduced. Furthermore, a decline in the number of diabetes-conditioned extra hospitalizations during pregnancy in the self-test group could be registered.

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The frequency of puerperal febrile complications is considerably higher following cesarean section than after vaginal delivery. In a retrospective investigation of 234 planned operations and 506 emergency operations, a significantly different frequency of febrile morbidity (FM) was found following the two types of operation (7.7% vs. 20.9%). The development of FM following emergency operation was investigated in relation to factors such as age, parity, repeat cesarean section, surgeon's experience, peroperative bleeding, rupture of membranes, frequency of vaginal exploration, gestational weeks, pre- and postoperative anemia. We found some predisposing factors to FM and of these five, each was significant, but a multiple regression analysis showed that only rupture of the membranes, and pre- and postoperative anemia have an independent significant explanatory value (p less than 0.01).

A 7-year survey of the outcome of pregnancy complicated by diabetes mellitus, carried out at the Aarhus center, is presented. The material comprised 344 diabetic pregnant women where the control was based mainly on a centralized ambulant regime. The latter half-period was moreover based on self-monitoring of the blood glucose level. This achieved a significantly better blood glucose regulation, with a reduction of the mean blood glucose level from 7.9 to 6.4 mmol/l. Furthermore, the introduction of self-monitoring halved the number of hospitalizations necessary for blood glucose regulation. Pregnancy was complicated in about 35%. The importance of screening for urinary tract infection is emphasized, since this, which was present in 20% of cases, might be a possible factor in ketoacidosis and/or intra-uterine growth retardation. In 19% of the vaginal births it was deemed necessary to give instrumental assistance; 5% had shoulder dystocia. The cesarean section frequency was 31%. The antenatal mortality rate was 1.2% and the uncorrected perinatal mortality was 3.5%, half of the neonatal mortality was due to fatal congenital malformations. About half of the newborn babies required immediate intensive neonatal treatment. Because of the high frequency of complications in pregnant diabetics, during childbirth and in the neonatal period, centralized monitoring by a highly specialized team is necessary in order to maintain the present relatively low perinatal mortality and morbidity rates and the low number of cesarean sections, together with the most convenient control regimen for this highly pathological group. Furthermore, centralization will facilitate research which, together with prepregnancy consultation, may reduce the frequency of major fetal malformations.