Diabetes in pregnancy: A clinical audit of cases delivered in the Maltese Islands during 1999-2004

In spite of several advances made in the last two decades in obstetric management, diabetes complicating pregnancy remains a high risk obstetric situation irrespective of whether the medical condition is pre-existing (pre-DM) or develops during pregnancy (GDM). The study reviews the outcome parameters of pre-DM (maternities = 98; infants born = 106) and GDM (mat. = 480; infants = 498) and compares these to those presumed to have normal metabolic profiles (mat. = 23668; infants = 23993) who delivered in the Maltese Islands during the six-year period 1999-2004. The study confirms that pre-DM carries definite obstetric morbidity risks for the mother and child - the mother showing significantly higher incidences of hypertensive disease and need for Caesarean delivery; while the infant shows a significantly higher morbidity arising from prematurity and attendant complications of low Apgar scores and respiratory distress. There was also a significant risk of macrosomia in these infants; congential malformations were only slightly increased though the difference did not show statistical significance. GDM similarly showed significant obstetric maternal morbidity risks with a significantly higher incidence of hypertensive disease, induction of labour and Caesarean deliveries. The infant similarly had significantly higher risks from prematurity, respiratory distress and macrosomia. The study confirms that in spite of the increased obstetric and metabolic intervention, the diabetic mother and her child remain at significant obstetric morbidity risks. St. Vincent's Declaration goal for diabetic pregnancies has yet to be achieved and may have been overambitious.