Pregnancy Complicating Diabetes: A Report of Clinical Results

Abstract

Hormone assays for chorionic gonadotrophin and pregnanediol were made after the 24th week of pregnancy in 125 consecutive cases in which preg-nancy complicated diabetes. 41 of the number had hormone excretion levels classified as normal and 77 had levels classified as abnormal. 27 of the latter received no replacement therapy. The clinical course of the 41 classified as normal appeared to be normal: none delivered prematurely, 2% developed toxemia, and 95% of the fetuses survived. The 27 cases classified as abnormal and untreated developed toxemia in 52%, premature delivery in 40% and 60% of the fetuses survived. Substitutional therapy was administered to 50 cases with abnormal hormonal excretion levels and 7 others classified as abnormal pregnancies because of past history or clinical signs. Toxemia appeared to be modified in this series, premature delivery occurred in 25%, and fetal survival was 92%. The management of the pregnant diabetic in our clinic includes hormone therapy if indicated by an imbalance of chorionic gonadotrophin and pregnanediol excretion, adequate control of carbohydrate metabolism, and premature delivery. The characteristics of the infants of diabetic mothers are: obesity, edema, and increase of organ size. The most striking change is hematopoiesis of the liver and spleen. 118 of the 119 mothers survived. 108 of the 125 fetuses survived, 2 of the 108 fetal survivors died in infancy. 15 of 17 fetal deaths occurred in the group with abnormal hormonal balance. From this study, it appears that fetal wastage is related to an imbalance of chorionic gonadotrophin and pregnanediol in pregnancy and that correction of the imbalance in this series appeared to be followed by fetal survival approaching that of the group classified as normal on the basis of hormonal assays and also approaching the fetal survival of non-diabetic pregnancies.