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Preterm birth is the main cause of neonatal morbidity and mortality, which is divided into three categories: preterm premature rupture of membrane (PPROM), preterm labor, and early delivery resulting from medical intervention. PPROM is defined as a condition in which the amniotic membranes are ruptured before 37 weeks of gestation and before the onset of labor, while the extreme PPROM occurs before 26 weeks of gestation (1). PPROM is associated with several risks for both mothers and fetuses. The most important maternal complication of PPROM is intra-amniotic infection (chorioamnionitis), which may affect fetus negatively, as well. Other fetal complications of PPROM are placental abruption, fetal distress, fetal restrictive deformities, pulmonary hypoplasia, preterm birth and fetal or newborn death (2-4). Diabetes mellitus or gestational diabetes is a complication which may be associated with PPROM outbreak or exacerbation during pregnancy. Diabetes mellitus is featured with hyperglycemia and impaired metabolism of carbohydrates, fatty acids and proteins and is associated with the absolute or relative lack of insulin. It is amongst the most common and costly diseases throughout the world whose prevalence rate is increasing because of the changed lifestyles and the improved medical and sanitary conditions, which in turn have enhanced the survival rate in the societies (5). In Iran, the general prevalence rate of diabetes and impaired glucose tolerance (IGT) in people of childbirth age is estimated about 7.6% (6). As the previous studies demonstrated, there is a direct relationship between (mellitus and gestational) diabetes and PPROM in pregnant women and unpleasant consequences of pregnancy (7-15). Given the considerable prevalence rate of (mellitus and gestational) diabetes during the childbirth age and the high possibility of infection and other neonatal and fetal complications in such pregnancies, which are exacerbated by PPROM, and since there has not been found any study covering maternal, neonatal and fetal complications in diabetic pregnant women with PPROM simultaneously (including in Iran), this study tries to consider maternal, fetal and neonatal complications of PPROM in women Abstract Objectives: It has been suggested that the presence of diabetes may increase the possibility of occurrence of premature rupture of the membrane (PPROM), which in turn, could lead to a dramatic escalation in the rate of pregnancy-related complications. The available data, however, are not sufficient in this regard in the literature. This study aims to examine pregnancy outcome in pregnant women with simultaneous diabetes mellitus/gestational diabetes and PPROM. Materials and Methods: A total of 134 pregnant women with gestational diabetes (n = 99) or diabetes mellitus (n = 35) were compared with 135 pregnant women normoglycemic women in terms of maternal, fetal and neonatal outcomes in a teaching hospital. Multiplepregnancy, anomalous fetus, complicated pregnancies, polyhydramnios, placental problems, and intrauterine growth restriction were exclusion criteria. Results: The three groups were comparable for the incidence of cesarean section, labor induction, chorioamnionitis, postpartum hemorrhage, need for ICU/NICU admission, placental retention, transfusion requirement, neonatal infection, respiratory distress, need for resuscitation, icterus, dystocia, need for insulin injection, and maternal/fetal mortality, as well as the mean Apgar and neonatal hospital stay. The mean maternal hospital stay and the duration of vaginal delivery were significantly shorter in controls than in patients with gestational diabetes. The rate of neonatal hypoglycemia was significantly higher in the group with diabetes mellitus compared to that in the two other groups. Conclusion: Except for the maternal hospital stay, duration of vaginal delivery and the incidence of neonatal hypoglycemia that were significantly better in normoglycemic mothers, the three groups were comparable for the remaining outcome variables.

international journal of women's health and reproduction sciences

Maternal, Fetal and Neonatal Outcomes in Mothers With Diabetes Mellitus or Gestational Diabetes That Complicated With Preterm Premature Rupture of the Membrane (PPROM)