PREGESTATIONAL DIABETES MELLITUS AND PREGNANCY

At the Department of Obstetrics and Gynecology, Perinatal Unit for Diabetes and Fetal Growth, Zagreb University School of Medicine, perinatal care of diabetes-complicated pregnancies has been practiced for more than 36 years now. The purpose of this paper is to present results of a study of diabetic pregnancies and latest clinical advances in the perinatal care of such pregnancies. Pregnancy complicated with diabetes is at risk for a number of maternal, fetal, and neonatal complications. Recent advances in medicine, especially in diabetology and perinatology, help the clinician avoid or lessen antenatal or perinatal complications in diabetic pregnancies. The main result of improved perinatal care is that today, the fetal and neonatal mortality in diabetic pregnancy is almost equal to that in the healthy pregnant population. Intensive preconceptional care and optimal regulation of insulin dependent diabetes have resulted not only in decreased perinatal mortality but also in a decreased rate of congenital malformations. On the other hand, tight glycemia control during pregnancy has an impact on fetal growth. Intensive control of fetal growth, verification of lung maturation at term by amniocentesis, and surveillance of fetal oxygenation will result in giving birth to a mature, eutrophic newborn with the lowest rate of neonatal complications possible. Perinatal mortality of less than 2% in diabetic pregnancy can be achieved by planned delivery between week 38 and 39 of gestation, either by the vaginal route or by cesarean section, depending on the indication. After delivery, intensive care of the newborn is required.