Optimised management of diabetic pregnancy reduces fetal loss.

Background and Aims: The outcome of pregnancy in diabetic women remains worse than that of their non-diabetic peers even in specialist units. We set out to optimise outcome in our established combined diabetesantenatal clinic. Materials and Methods: Following an audit in 1995, services were reorganised, targeting more intensive diabetes management and increased use of fetal monitoring to determine timing of delivery. Fetal outcome was monitored throughout 1996-2002. Results: Between 1992-95, 197 pregnancies occurred in 99 gestational (GDM) and 98 established (EDM) diabetic women; compared with 441 (297 GDM and 144 EDM) between 1996-2002. Fetal loss rate (still births and lethal congenital abnormalities) in the first cohort was 60.9 per 1000, similar to published rates from specialist services elsewhere, and fell to 13.6 per 1000 in the second. In the first cohort, there were 7 still births (2 GDM; 1 Type 2 and 4 Type 1 DM) and 5 lethal congenital abnormalities (2 Type 2; 3 Type 1); in the 2nd there were 5 still births (3 GDM; 1 Type 2, 1 Type 1) and 1 lethal congenital abnormality (1 GDM). This equals a fall in fetal loss in the GDM from 20.2 to 13.5 per 1000 and in EDM from 102 per 1000 to 13.9, against a background rate for our local population of ~10.8 per 1000. Intervention rates and gestational age at delivery remained stable throughout both periods but in the second, early delivery in a small number of cases was indicated by adverse fetal monitoring. Conclusion:We conclude that in diabetes, both gestational and established, better fetal outcome can be achieved by intensive management regimens.