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

Abstract

The hazards associated with pregnancy in the insulin-dependent diabetic have altered considerably within the past 60 years. 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. It has been suspected since the observations of Pedersen 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. Since the advent of measuring haemoglobin A1 (HbA1) as an index of diabetic control, studies have been undertaken and are continuing in several centres to relate the outcome of pregnancy to HbA1 levels during pregnancy. Studies published so far suggest an association between high HbA1 in early pregnancy and congenital abnormalities. This was one of several considerations behind the establishment in Edinburgh towards the end of 1976 of what was probably the first prepregnancy clinic for diabetics. Our five years' experience of this clinic, which we now report, has convinced us of its value in assessing factors that can contribute to the better management of pregnancy in the diabetic.