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| |  Stillbirths, Malformations In Children Of Diabetic Mothers Could Be Prevented LONDON -- August 1, 1997 -- Children born to women who suffer from insulin-dependent diabetes (IDD) are 10 times more likely to have congenital anomalies and five times more likely to be stillborn, says a paper in this week's British Medical Journal (BMJ). The authors studied 462 pregnancies in 355 women with IDD in 10 maternity units in Cheshire, Lancashire, and Merseyside which had no regional guidelines for the management of pregnancy in diabetic women. Although there were 351 live births, 78 miscarried spontaneously, 9 resulted in stillbirth This prevalence of congenital defects can be reduced by good management of blood sugar levels before and at the time of conception, say the authors, but the challenge will be to implement this through the diabetic population. Diabetic pregnancy remains a high risk state, says another paper in this week's BMJ. In 1989, say the authors, the St. Vincent declaration stated as a five-year goal that "outcome of diabetic pregnancy should approximate that of the non-diabetic population". The researchers studied the records of all diabetic pregnancies during 1994 in the former Northern regional health authority and compared them with non-diabetic pregnancies in the same region. They found that the perinatal mortality rate among children born to diabetic mothers was five times higher, the neonatal mortality rate 15 times higher, and the congenital malformation rate four times higher than in the general population. There was also a substantial excess of premature births among diabetic mothers. The outcome of diabetic pregnancy remains poor, they conclude. "Though two thirds of the pregnancies were planned by the mother, most women had not established good diabetic control before conception. Preconceptual care reduces major congenital malformations and the spontaneous abortion rate. It is essential that we should improve delivery of this cost effective care." Why has the U.K. not achieved the St. Vincent declaration's target on the reduction of mortality and malformation among babies born to women with diabetes, asks an editorial in the same issue of BMJ. Pregnancy outcomes in Scandinavia have improved to the extent that, in Sweden, the rate of spontaneous abortion is similar between diabetic and non-diabetic women, and rates of congenital malformation have more than halved. It would seem, says the author, that regular blood sugar monitoring among women who are pregnant or planning to be so should ensure that the St.Vincent's target would be reached. But with unplanned pregnancies and pregnancies among women who have not received preconceptual care still common, the services for non-pregnant women need to be as effective as for those attending preconceptual or ante-natal clinics. "This means that diabetes services in general need to be reconfigured to optimise glycaemia over the whole population," the author concludes.
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