Document Detail


How to improve prognosis in type 1 diabetic pregnancy. Old problems, new concepts.
MedLine Citation:
PMID:  10097909     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To improve the prognosis of pregnancy in type 1 diabetes. RESEARCH DESIGN AND METHODS: This study is an epidemiological analysis of pregnancy outcome in type 1 diabetic mothers attending the combined diabetic antenatal clinic at the Royal Maternity Hospital, Belfast, from 1940 to 1990. Short-term measurement of maternal insulin sensitivity and of intrauterine fetal habituation was taken in selected pregnancies. The article also assesses the European and U.K. recommendations for diabetes in pregnancy, with a goal "to achieve pregnancy outcome in the diabetic woman that approximates that of the non-diabetic woman." RESULTS: Outcomes from 1985 to 1995 in > 800 pregnancies, of which about 60% were delivered at the Regional Centre, suggested that the perinatal mortality was lower for those managed throughout at the center. The highest obstetric risk was in those pregnancies referred to the center at some point later in the pregnancy from a peripheral obstetric clinic. Studies of insulin sensitivity in normal and preeclamptic pregnancy by minimal-model analysis of a frequently sampled intravenous glucose tolerance test and of glycosylated hemoglobin in a large survey of nondiabetic pregnancy indicate that the pregnant state may unmask an increase in insulin resistance, causing both pregnancy-induced hyperglycemia and pregnancy-induced hypertension. Fetal habituation, studied by responses to a variable sound stimulus, was less effective in diabetic pregnancy, which may indicate changes in fetal brain function. CONCLUSIONS: Pregnancy in a type 1 diabetic mother remains a high-risk obstetrical situation, even with presently available intensive diabetic supervision.
Authors:
D R Hadden
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Diabetes care     Volume:  22 Suppl 2     ISSN:  0149-5992     ISO Abbreviation:  Diabetes Care     Publication Date:  1999 Mar 
Date Detail:
Created Date:  1999-05-27     Completed Date:  1999-05-27     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7805975     Medline TA:  Diabetes Care     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  B104-8     Citation Subset:  IM    
Affiliation:
Sir George E. Clark Metabolic Unit, Royal Victoria Hospital, Belfast, Northern Ireland, U.K. davidhadden@general.rght.n-i.nhs.uk
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MeSH Terms
Descriptor/Qualifier:
Centralized Hospital Services
Congenital Abnormalities / etiology
Diabetes Mellitus, Type 1 / complications,  epidemiology,  physiopathology*
Female
Finland / epidemiology
Humans
Hyperglycemia / complications
Hypertension / complications
Infant, Newborn
Ireland / epidemiology
Pregnancy
Pregnancy Outcome*
Pregnancy in Diabetics / epidemiology,  physiopathology*
Prognosis

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


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