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Korean Journal of Obstetrics & Gynecology 1998;41(2):593-601.
Published online January 1, 2001.
Pregnancy Outcomes According to the Status of Maternal Blood Glucose Control in Pregnant Women with Diabetes Requiring Insulin Therapy.
J Choi, B H Yoon, K B Bai, S T Choi, J H Kwon, J K Jun, H C Shin
Abstract
OBJECTIVE
To compare the pregnancy outcomes according to the status of maternal blood glucose control during pregnancy in women with diabetes requiring insulin therapy. Study design: Between 1986 and 1996, 83 pregnant women with diabetes who requires insulin therapy during pregnancy were identified; 29 cases with pregestational diabetes and 54 with gestational diabetes. The status of maternal blood glucose control was determined according to the mean HbA1c concentration (below or above 6.0% of HbA1c) during the third trimester of pregnancy. Pregnancy outcomes were compared between two groups of patients. RESULTS: 1) Patients with poor blood glucose control (HbA1c > 6.0%) had a significant higher rate of adverse outcome including cesarean delivery due to either fetal distress or cephalo-pelvic disproportion (20.0% vs. 2.9%, p<0.05), macrosomia of the newborn (> 90th percentile for gestation; 44.0% vs. 5.7%, p<0.0001), higher mean birth weight (3.61+/-1.12 kg vs 3.08+/-0.48 kg, p<0.005), and neonatal hypoglycemia at birth (42.2% vs. 12.1%, p<0.005); 2) The rate of preterm delivery (< 37 weeks of gestation) and pregnancy-induced hypertension was higher in patients with poor control (HbA1c > 6.0%) than those with good control (HbA1c< 6.0%) (16.0 % vs. 5.7% for each) without reaching statistical significance; 3) There was no statistical differences in the mean gestational age at birth and the rate of perinatal death between the two groups of patients. CONCLUSIONS: Poor maternal glucose control is a risk factor for the development of adverse perinatal outcome including higher rate of fetal macrosomia, cesarean section, and neonatal hypoglycemia at birth.
Key Words: Diabetes, Insulin, Blood glucose control, Perinatal morbidity, Maternal morbidity


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