An Analysis of Diabetic Pregnancies at Mayo Clinic, 1950–79

Lufkin, Edward G.; Nelson, Roger; Hill, Linda; Melton, L. Joseph; O’Fallon, W. Michael; Evans, Alun

doi:10.2337/diacare.7.6.539

Cited by 41 publications

(12 citation statements)

References 18 publications

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“…This conforms with the results of previous studies in that there is a substantial increase of pre-eclampsia among women with Type I diabetes [6,11]. Our results also confirm that diabetic nephropathy before pregnancy considerably accentuates this risk [4].…”

Section: Discussionsupporting

confidence: 82%

Glycaemic control is associated with pre-eclampsia but not with pregnancy-induced hypertension in women with Type I diabetes mellitus

2000

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It has long been known that Type I (insulin-dependent) diabetes mellitus considerably increases the risk of pre-eclampsia and maternal and fetal co-morbidity [1±3]. The most important risk factor of pre-eclampsia in women with diabetes is nephropathy (White's class F) [1]. Even incipient nephropathy substantially increases the risk [4]. In addition, retinopathy and long duration of diabetes also increase the risk of pre-eclampsia [5±8].Although an association between poor glycaemic control in early pregnancy and pre-eclampsia has been reported [4, 7±11], it has not been observed by all [12]. It is not clear to what extent glycaemic control in early pregnancy might exert an effect on the occurrence of pre-eclampsia. Diabetic women with HbA 1 c values greater than 8 % could be at a greater risk of pre-eclampsia than those with values less than 8 % [10]. It is not known whether the risk of pre-eclampsia in diabetic women with relatively good gly- Abstract Aims/hypothesis. To investigate the association between glycaemic control and hypertensive pregnancy complications. Methods. From 1988 to 1997, we followed up 683 consecutive non-selected pregnancies in women with Type I (insulin-dependent) diabetes mellitus. Glycaemic control was assessed by assay of HbA 1 c . Pre-eclampsia was defined as diastolic blood pressure of 90 mmHg or more at the end of pregnancy after an increase of 15 mmHg or more, combined with proteinuria of 0.3 g or more for 24 h. Pregnancy-induced hypertension was defined similarly but without proteinuria. The same criteria were applied to a control group of 854 non-selected non-diabetic women. Results. Pre-eclampsia developed in 12.8 % of the women with diabetes (excluding those with nephropathy before pregnancy) and in 2.7 % of the control women (odds ratio 5.2; 95 % CI 3.3±8.4). In multiple logistic regression, glycaemic control, nulliparity, retinopathy and duration of diabetes emerged as statistically significant independent predictors of pre-eclampsia. The adjusted odds ratios for pre-eclampsia were 1.6 (95 % CI 1.3±2.0) for each 1 % increment in the HbA 1 c value at 4±14 (median 7) weeks of gestation and 0.6 (0.5±0.8) for each 1 % decrement achieved during the first half of pregnancy. Changes in glycaemic control during the second half of pregnancy did not significantly alter the risk of pre-eclampsia. Unlike pre-eclampsia, the risk of pregnancy-induced hypertension was not associated with glycaemic control. Conclusion/interpretation. In women with Type I diabetes, poor glycaemic control is associated with an increased risk of pre-eclampsia but not with a risk of pregnancy-induced hypertension. [Diabetologia (2000

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Section: Discussionsupporting

confidence: 82%

Glycaemic control is associated with pre-eclampsia but not with pregnancy-induced hypertension in women with Type I diabetes mellitus

2000

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“…were collected in a single clinic over the period 1950-1979, and no trend in perinatal mortality was found when the data were analyzed by decade (11). However, an abrupt decline in perinatal mortality late in the 1970s might have gone undetected in this analysis.…”

Section: Discussionmentioning

confidence: 93%

Determinants of IDDM and Perinatal Mortality in Children of Diabetic Mothers

1988

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Offspring of women with insulin-dependent diabetes mellitus (IDDM) have a lower risk of developing IDDM than offspring of men with IDDM (1). To determine whether the risk of diabetes in offspring of diabetic mothers has changed after dramatic improvements in perinatal survival of these infants, we undertook a follow-up study of 1602 pregnancies of 739 women with IDDM who were patients at the Joslin Diabetes Center. Improvements in perinatal survival were abrupt rather than gradual. During the two decades before 1961, perinatal mortality was stable around 23%. After a sudden drop in 1961, it stabilized around 14% until 1975, when it was brought down to 4%, where it has remained. Of the 1391 offspring who survived the neonatal period, IDDM has developed in 21, a cumulative risk of 2.1 +/- 0.5% (SE) by age 20 yr. This is one-third the risk previously reported for offspring of fathers with IDDM and is independent of the calendar time of the births (1). The risk of diabetes in offspring of diabetic mothers is increased in young mothers and is otherwise independent of risk factors for perinatal mortality in this series. We conclude that there is no evidence that selective loss of diabetes-susceptible fetuses in perinatal deaths is a mechanism for the lower incidence of IDDM in the offspring of mothers with IDDM than in those of fathers with IDDM. The principal alternative mechanism is that exposure in utero to an affected mother can protect a fetus from developing IDDM later in life. Induction of immunologic tolerance to the autoantigens of the beta-cells is a plausible mechanism for this protective effect.

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“…Despite attention to all these measures, macrosomia will still occur but should not be associated with significant perinatal complications if the patient has achieved good glycemic control in the latter half of pregnancy and if neonatal hypoglycemia is rapidly detected and corrected. Even if good glycemic control in pregnancy will not guarantee the birth of a nonmacrosomic infant, there is such compelling evidence that meticulous diabetic control reduces perinatal morbidity and mortality that euglycemia remains the therapeutic aim for every diabetic patient during pregnancy (8,19,(27)(28)(29)(30)(31).…”

Section: Resultsmentioning

confidence: 99%

Macrosomia in Pregnancy Complicated by Insulin-Dependent Diabetes Mellitus

et al. 1987

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We assessed the factors influencing the birth weight of infants born to 83 women with insulin-dependent diabetes mellitus (IDDM) over a 5-yr period. Maternal glycosylated hemoglobin (HbA1) concentrations at delivery correlated with the percentile birth-weight ratios (r = .43, P less than .001) and indicated that approximately 18% of variance in the birth weight could be ascribed to glycemic control in the third trimester. Fetal macrosomia occurred in 22 (27%) pregnancies. When 20 of these pregnancies were compared closely with 20 nonmacrosomic pregnancies in diabetic women, the mothers of macrosomic infants were found to be more obese, have a history of previous macrosomic birth, and have higher concentrations of serum human placental lactogen and urinary estriols in the third trimester. Macrosomic pregnancy was further distinguished by accelerated fetal growth (judged by serial ultrasonography) from the 32nd wk of gestation and by biochemical (but asymptomatic) hypoglycemia in the neonate. In our study, no serious neonatal morbidity could be attributed to macrosomic pregnancy. Good glycemic control was attained in both groups, and no significant differences between the groups in overall glycemic control throughout pregnancy were noted. Thus, despite good glycemic control, macrosomia remains comparatively common in modern pregnancy complicated by IDDM, and factors other than maternal hyperglycemia must contribute to its etiology.

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An Analysis of Diabetic Pregnancies at Mayo Clinic, 1950–79

Cited by 41 publications

References 18 publications

Glycaemic control is associated with pre-eclampsia but not with pregnancy-induced hypertension in women with Type I diabetes mellitus

Glycaemic control is associated with pre-eclampsia but not with pregnancy-induced hypertension in women with Type I diabetes mellitus

Determinants of IDDM and Perinatal Mortality in Children of Diabetic Mothers

Macrosomia in Pregnancy Complicated by Insulin-Dependent Diabetes Mellitus

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