Pregnancy outcome in insulin-dependent diabetes: temporal relationships with metabolic control during specific pregnancy periods.

There are specific temporal relationships between metabolic control during different periods of pregnancy and outcome in insulin-dependent diabetic pregnancies. The rate of spontaneous abortions correlates with poor periconceptional glycemic control. Major malformations and decreased infant bone mineral content at birth correlate with poor first trimester glycemic control. Increased rates of preeclampsia and premature labor correlate with poor glycemic control in the second trimester. The development of macrosomia and that of neonatal hypoglycemia correlate with poor third trimester glycemic control. Perinatal asphyxia and neonatal hypoglycemia correlate with hyperglycemia in labor. We suggest that each stage of the pregnancy, if complicated by poor glycemic control, may lead to specific, temporally related complications. Glycemic control from the periconceptional period to the time of delivery appears important in order to minimize complications of the insulin-dependent diabetic pregnancy.