Pregnancy in insulin-dependent diabetics. A 5 1/2-year study at Groote Schuur Hospital.

During a 5 1/2-year period we have seen only 39 pregnant women with insulin-dependent diabetes, as opposed to 171 with established insulin-independent diabetes. Tight control with two injections of mixed insulins per day was attempted, but satisfactory blood glucose values were obtained in only 16 cases. Nevertheless the overall perinatal mortality rate was 77/1000; of the 3 infants which died 2 had lethal congenital abnormalities and 1 was born to a mother whom we had been seeing for only 4 weeks. Perinatal morbidity was similar to that in other series, except that few of our infants were oversized, hyaline membrane disease was uncommon, and only 2 had a low Apgar score. Fourteen infants weighed less than 2500 g. Hypoglycaemia in the newborn appears to be much reduced by the use of continuous low-dose intravenous insulin infusion during labour or caesarean section. To reduce perinatal mortality further, we conclude that exact blood glucose control should be attained before conception.