ABSTRACT
The objective of this paper is to evaluate the impact of contemporary management on
the maternal and neonatal outcomes of pregnancies complicated by diabetes in women
with microvascular disease versus women without microvascular disease. The study population
consisted of two hundred and eighty-eight (288) pregnant women with pregestational
diabetes and one hundred and fifty (150) healthy pregnant controls. Diabetic women
were grouped according to the presence (n = 103) or absence of diabetic microvascular disease (n = 185). Data were collected regarding diabetes management, level of glycemic control,
and the development of antenatal complications. Maternal and neonatal outcomes were
compared among the three groups. Women in the diabetes groups were stratified according
to mean blood glucose levels and glycosylated hemoglobin during each trimester. There
was no significant difference found between the two diabetes groups in terms of preterm
labor, polyhydramnios, pyelonephritis, and growth restriction. The only maternal complications
that occurred with increased incidence among women with microvascular disease were
acute hypertensive complications (5I.6 vs. 32.9%; p < 0.05). However, when the diabetes groups were compared to healthy controls, a significant
difference was seen in all maternal and neonatal complications. Preterm delivery,
polyhydramnios, and large-for-gestational-age (LGA) infants were associated with poor
third-trimester metabolic control as compared with others in satisfactory metabolic
controls: 30.8 vs. 11.4% for preterm delivery; 1 7.3 vs. 5.1 % for polyhydramnios;
51.9 vs. 33.9% for LGA; p < 0.05. Congenital malformations were associated with poor first-trimester glucose
control (5.8 vs. 1.3% anomalies in well-controlled women). Furthermore, major congenital
malformations were also significantly increased in the offspring of women with diabetic
microvascular disease 6.8%, as compared to 1.69% in diabetic women without microvascular
disease; p < 0.01. The incidence of hypertensive complications did not differ between the two
diabetic groups. Pregestational diabetic women with and without microvascular disease
can be counseled to anticipate comparably favorable pregnancy outcomes, although maternal
and neonatal complications may exceed that experienced by pregnant women without diabetes
mellitus.
Keywords
Diabetes - pregnancy - microvasclar disease - maternal and neonatal outcomes
