NEW APPROACH TO THE TREATMENT OF DIABETIC PREGNANT-WOMEN - REPORT OF 479 CASES SEEN FROM 1963 TO 1975

From 1963 to 1975, 479 pregnant diabetic women and 484 newborn infants were treated. Insulin was administered to a MTD in both patients with clinical and those with latent diabetes. The control of maternal diabetes is 'as strict as possible' and can be guaranteed 'a priori' in every case. The total and corrected perinatal death rates in this study were, respectively, 2.9% and 1.9%. The birth weights were similar to those of neonates of nondiabetic mothers (neonates weighing more than 4,000 grams, 3.4%). Serious malformations were reduced to 2.4%. Labor began spontaneously in 90% of cases and cesarean section was performed in 24.6% of cases (a quarter of them in multiparas who had undergone cesarean section in previous pregnancies). The results show that the perinatal risk in pregnant diabetic women can be reduced to a level comparable to that in nondiabetic pregnant women. Excellent control of maternal diabetes throughout pregnancy is confirmed to be essential for the best fetal prognosis. The adopted criterion of insulin administration seems to fulfill this requirement. It can be also applied to pregnant women with latent diabetes, in whom insulin therapy can reduce fetal risk.