Diabetic Pregnancy 1977–1990: Have We Reached a Plateau?

We have compared 81 pregnancies in women with type 1 (insulin dependent) diabetes in 1984–1990 with 58 in 1977–1983. In 1984–1990, women booked earlier (8 weeks [median] vs 12 weeks), mean haemoglobin A1 was lower in each trimester, and fewer days were spent in hospital before delivery (5.3 days [mean] vs 15). The latter was due to more experience in managing diabetic control as out-patients and fewer admissions for fetal monitoring. Most admissions are now for pre-eclampsia and intercurrent illnesses. The proportion of deliveries by caesarean section has not changed significantly (53% in 1984–1990 vs 66% in 1977–1983), but most are now done as emergencies. The incidence of macrosomia is constant (26% in 1984–1990 vs 21% in 1977–1983). There was one stillbirth, one intra-uterine death (complicating maternal ketoacidosis) and one perinatal death in 1984–1990, compared with no losses in 1977–1983. Two babies had major congenital abnormalities in 1984–1990, compared with one in 1977–1983. These results compare favourably with those from other centres in the United Kingdom. We conclude we have reached a nearly irreducible minimum for hospital days before delivery and congenital abnormalities, but that there is scope for a small reduction in the caesarean section rate.