Schwangerschaftsausgang unter intensivierter Insulintherapie bei manifestem Diabetes*

Abstract

In 1981, the intensified insulin therapy for achievement of euglycaemia in pregnant diabetics was introduced at the University Department of Obstetrics and Gynaecology in Cologne. This study compares the results of 112 pregnancies in women with overt diabetes monitored before (1971-1980) or after (1981-1988) changing the therapeutic regimen. In the period from 1981 to 1988, the proportion of euglycaemic patients (preconceptionally 19%, before delivery 79%) was clearly higher than from 1971 to 1980 (n = 42; 7% and 9%, respectively). The tight blood glucose control resulted in a doubling of hypoglycaemic episodes during pregnancy. The proportion of preterm deliveries was reduced from 47% to 24%. The rate of caesarean sections was nearly constant (1971-1980: 38%, 1981-1988: 34%). The marked success of therapy was the decrease of perinatal mortality from 20.9% to 2.9%. The perinatal morbidity also diminished, as shown by the decreasing rates (30-90%) of foetopathy, macrosomy, respiratory distress syndrome, birth trauma, hypoglycaemia, hypocalcaemia and polycythaemia. The malformation rate, however, remained high (1971-1980 = 7%, 1981-1988 = 11%). The results demonstrate the necessity of a strict blood glucose control during pregnancy, beginning before the time of conception.

Insulin Use in Pregnancy

“…The main risk of strict metabolic control in 100M is severe maternal hypoglycaemia (20 to 40%) requiring intervention by another trained person (Bergmann et al 1987;Crombach et al 1990;Hillebrand et al 1990;Rayburn et al 1986;Steel et al 1989). So far, clinical studies have not presented any evidence that hypoglycaemia in early pregnancy is related to congenital malformations in humans (Mills et al 1988;Steel et al 1989).…”

“…Target values for different laboratory parameters for strict metabolic control of pregnant diabetics; glucose levels in venous whole blood are generally 5 to 15% lower than those in capillary whole blood and in venous plasma (Diabetic Pregnancy Study Group 1989). Data summarised here are from Burkart et al (1986); Crombach et al (1990); Gabbe (1985); Hare (1991); Hofmann et al (1990); Jovanovic et al (1982); Somville (1990); Weiss, personal communication (1987) laboratory parameter/ level time period Capillary venous whole blood glucose (mg/dl) before breakfast 60-90 before lunch/supper, at bedtime 60-105 1 h after meal 70-140 2h after meal 2am to 6am mean day value HbA1 (%) HbA1c (%) Serum fructosamine (mmol/l) Amniotic fluid insulin (>28 gw) [mUll] 60-120 60-100 80-100 <7.0-7.5 <5.0-5.5 <2.6 <6-10 (10) Abbreviations: HbA1, HbA1C = glycosylated haemoglobin; gw = gestational weeks.…”

“…At present, ICT is the therapy most frequently used in diabetic pregnancies (Crombach et al 1990;Freinkel et al 1990;Somville 1990). The basal insulin secretion is mimicked by 1 to 3 injections of an intermediate-or long-acting insulin.…”

Effect of screening and management of diabetes during pregnancy on stillbirths

“…Observational studies which looked at similar comparisons were also identified [28,32,33,35,49,50,75]. A cohort study by Huddle et al (2005) [50] focused on pregestational and gestational diabetes in a population of black women.…”

Relationship between amniotic fluid insulin and maternal blood glucose concentrations in patients with carbohydrate intolerance during pregnancy

“…Although perinatal mortality can be decreased to 1-3% by tight metabolic control, perinatal morbidity is still high [6,27]. Fetal hyperinsulinism is considered to be the main pathogenetic mechanism for diabetes-specific neonatal complications (fetopathy, macrosomia, hypoglycemia).…”