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Five years' experience of a "prepregnancy" clinic for insulin-dependent diabetics.

1982; BMJ; Volume: 285; Issue: 6338 Linguagem: Inglês

10.1136/bmj.285.6338.353

0959-8138

J M Steel, F. D. Johnstone, A.F. Smith, Lorna Duncan,

Gestational Diabetes Research and Management

The hazards associated with pregnancy in the insulin-dependent diabetic have altered considerably within the past 60 years.1 Nowadays there is rarely a serious risk to the life or health of the mother, while the "classical" grotesquely obese offspring, prone to respiratory distress syndrome and dangerous metabolic disturbance in the neonatal period, is seldom encountered.The frequency of severe congenital abnormalities, however, does not appear to have declined, and this now constitutes the major target for further improvement in the management of the pregnant diabetic.'Most of these abnormalities occur before seven weeks' gestation.3It has been suspected since the observa- tions of Pedersen4 that congenital abnormalities are related to poor diabetic control during the early stages of pregnancy, and work in rats has suggested that hyperglycaemia in early pregnancy is associated with a high incidence of congenital abnormalities.5Since the advent of measuring haemoglobin Al (HbAJ) as an index of diabetic control, studies have been undertaken and are continuing in several centres to relate the outcome of pregnancy to HbAl levels during pregnancy.Studies published so far suggest an association between high HbAl in early pregnancy and congenital abnormalities. 6-8 This was one of several considerations behind the establish- ment in Edinburgh towards the end of 1976 of what was probably the first prepregnancy clinic for diabetics.9Our five years'