Pregnancy Outcomes According to the Status of Maternal Blood Glucose Control in Pregnant Women with Diabetes Requiring Insulin Therapy

Choi, J; Yoon, B H; Bai, K B; Choi, S T; Kwon, J H; Jun, J K; Shin, H C

Abstract

OBJECTIVE
To compare the pregnancy outcomes according to the status of maternal blood glucose control during pregnancy in women with diabetes requiring insulin therapy. Study design: Between 1986 and 1996, 83 pregnant women with diabetes who requires insulin therapy during pregnancy were identified; 29 cases with pregestational diabetes and 54 with gestational diabetes. The status of maternal blood glucose control was determined according to the mean HbA1c concentration (below or above 6.0% of HbA1c) during the third trimester of pregnancy. Pregnancy outcomes were compared between two groups of patients.
RESULTS
1) Patients with poor blood glucose control (HbA1c > 6.0%) had a significant higher rate of adverse outcome including cesarean delivery due to either fetal distress or cephalo-pelvic disproportion (20.0% vs. 2.9%, p<0.05), macrosomia of the newborn (> 90th percentile for gestation; 44.0% vs. 5.7%, p<0.0001), higher mean birth weight (3.61+/-1.12 kg vs 3.08+/-0.48 kg, p<0.005), and neonatal hypoglycemia at birth (42.2% vs. 12.1%, p<0.005); 2) The rate of preterm delivery (< 37 weeks of gestation) and pregnancy-induced hypertension was higher in patients with poor control (HbA1c > 6.0%) than those with good control (HbA1c< 6.0%) (16.0 % vs. 5.7% for each) without reaching statistical significance; 3) There was no statistical differences in the mean gestational age at birth and the rate of perinatal death between the two groups of patients.
CONCLUSIONS
Poor maternal glucose control is a risk factor for the development of adverse perinatal outcome including higher rate of fetal macrosomia, cesarean section, and neonatal hypoglycemia at birth.