Document Detail


Effect of management policy upon 120 Type 1 diabetic pregnancies: policy decisions in practice.
MedLine Citation:
PMID:  10445833     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: To evaluate the outcome of two specific changes in the policy of managing pregnancy in Type 1 diabetes over a 5-year period. The need for change had been identified following an audit in the previous 5-year period: firstly, the need for intensive effort to improve the uptake of pre-pregnancy counselling; secondly, a modest relaxation of the targets for blood glucose control during labour to minimize the risk of maternal hypoglycaemia. METHODS: Data were collated from maternal and neonatal case notes from all women with Type 1 diabetes mellitus managed by Newcastle obstetric services between August 1989 and July 1994 (n = 80), comparing data with 40 such women looked after between November 1985 and July 1989. RESULTS: The age of the women, blood glucose control during pregnancy, gestation at delivery, and birth weight were similar in the 5-year period under study to those previously reported for the first study period. Mean blood glucose in labour for Period 2 was 5.5 +/- 0.6 mmol/l, exactly 1.0 mmol/l higher than the mean blood glucose achieved in labour for Period 1. As a consequence, only 22.5% women (18/80) experienced one or more episodes of blood glucose less than 3.0 mmol/l compared with 40.0% women in Period 1 (16/40) (P < 0.01). There was no effect of maternal blood glucose on neonatal blood glucose provided the former was within the range 4-8 mmol/l during labour. However, if maternal blood glucose was over 10 mmol/l, the infant's blood glucose was always low (1.3 +/- 0.8 vs. 2.5 +/- 1.5 P < 0.02). Macrosomia (over the 90th percentile for gestational age) was observed in 43.1% of infants in Period 1, and the mean birth weight was not different from Period 1. In the initial 5-year period 27.5% (11/40) women received specific pre-pregnancy care for their diabetes, compared with 21.3% (17/80) in Period 2 despite the intensive programme of education. There were six cases of congenital abnormality and two antepartum deaths (10% adverse outcome). CONCLUSIONS: The target range for blood glucose control in labour of 4-7 mmol/l minimizes maternal hypoglycaemia in labour and the data indicate that an upper limit of 8 mmol/l would not increase the risk of neonatal hypoglycaemia. Fresh thought is required about the matter of preventing congenital abnormalities by achieving better pre-pregnancy and peri-conception blood glucose control.
Authors:
S Carron Brown; D Kyne-Grzebalski; B Mwangi; R Taylor
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Diabetic medicine : a journal of the British Diabetic Association     Volume:  16     ISSN:  0742-3071     ISO Abbreviation:  Diabet. Med.     Publication Date:  1999 Jul 
Date Detail:
Created Date:  1999-09-14     Completed Date:  1999-09-14     Revised Date:  2005-11-17    
Medline Journal Info:
Nlm Unique ID:  8500858     Medline TA:  Diabet Med     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  573-8     Citation Subset:  IM    
Affiliation:
Royal Victoria Infirmary, Newcastle upon Tyne, UK.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Birth Weight
Blood Glucose / metabolism
Counseling
Diabetes Mellitus, Type 1 / therapy*
England
Female
Humans
Infant, Newborn / blood,  physiology*
Maternal Health Services / organization & administration*
Obstetric Labor Complications
Pregnancy
Pregnancy Outcome
Pregnancy in Diabetics / therapy*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Blood Glucose

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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