PROGNOSIS OF THE OUTCOME OF PREGNANCIES IN DIABETICS

Abstract

In order to improve the possibilities of predicting the outcome of pregnancy in diabetics, a consecutive series of 304 pregnancies in 263 diabetic women in the Royal Maternity Department B, Rigshospitalet, Copenhagen, was analysed during the 5-year period 1959-1963. The period of supervision and treatment during pregnancy varied greatly. The perinatal mortality in the 306 infants was 17.9%. According to the results of this analysis, patients with a poor prognosis were divided into the following 4 groups: Pregnant women who developed: hyperpyretic pyelitis; pre-coma or severe acidosis; toxemia, or patients who could be so described; neglectors. These 4 groups, and the classification, are designated PBSP (Prognostically Bad Signs during Pregnancy). The mothers of 130 infants belonged to 1 or more of the 4 groups of PBSP, and among the infants of these mothers the perinatal mortality was 31.5% as compared with 7.9% in the group of 176 infants without PBSP during pregnancy. The poor prognosis for the pregnancies with PBSP applies to all fetal weight groups. In addition, these pregnancies terminate in premature delivery twice as often as the others. It is demonstrated that from the prognostic point of view, nothing is gained by including hydramnios in PBSP. The risk involved by a PBSP complication to the fetus depends on the White (1949) class in which it occurs. A combination of White''s classification of pregnant diabetics with regard to fetal prognosis used together with the present classification improves the possibility of predicting the fetal prognosis in a series of pregnant diabetics which is mixed as regards the length of treatment during pregnancy.