Pregnancy can go well for women with diabetes

Women with type 1 diabetes who monitor their blood glucose daily both before and during pregnancy have better outcomes, Danish researchers report.

In the largest study to date of pregnant women with type 1 diabetes, Dr. Dorte M. Jensen of Odense University Hospital and colleagues found that only one-third of women said they monitored their blood sugar levels every day around the time they conceived.

Daily monitoring and good overall control of blood glucose levels were associated with a lower likelihood of infant mortality and birth defects.

The study is published in the medical journal Diabetes Care.

Specifically, the researchers compared rates of pregnancy complications in the general population with rates for 1,218 consecutive pregnancies in 990 women who had type 1 diabetes.

Among the women with diabetes, compared with the general population, the percentage of babies that died soon after birth was higher (3.1 percent vs. 0.75 percent), as was the rate of stillbirths (2.1 percent vs. 0.45 percent) and birth defects (5.0 percent vs. 2.8 percent).

Among the 93 diabetic women who had serious adverse outcomes - meaning babies that died or had malformations - 22 percent monitored their blood glucose daily at conception, compared to 35 percent of the women who had uncomplicated pregnancies.

Also, blood sugar control before and during pregnancy was not as good among the adverse outcome group, on average, and they were less likely to have received pre-conception guidance than the women without seriously affected babies.

In Denmark, where healthcare is free and women with diabetes are entitled to regular visits with diabetes specialists, the researchers note, the low rates of daily monitoring at conception and pre-conception guidance were "disappointing."

"Our data suggest that glycemic control, self-care and education of the patient still need to be improved significantly and that adequate control using daily glucose monitoring in all patients is a crucial step towards reaching the goals of the St. Vincent declaration," Jensen's team concludes.

That 1989 declaration stated that within five years, rates of complications in diabetic pregnancies should be similar to those seen with non-diabetic pregnancy - a goal that has not been achieved, the researchers note.

SOURCE: Diabetes Care, December 2004.