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Prospective Study of 3 Metabolic Regimens in Pregnant Diabetics
Author(s) -
Farrag O. A. M.
Publication year - 1987
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1987.tb00921.x
Subject(s) - medicine , pregnancy , fetus , incidence (geometry) , empagliflozin , metabolic control analysis , obstetrics , gestational diabetes , caesarean section , diabetes mellitus , pediatrics , endocrinology , gestation , type 2 diabetes , genetics , physics , optics , biology
EDITORIAL COMMENT: Tight control of blood sugar values (below 5.6 μmol/l) has many advocates and has been associated with reduction in perinatal mortality rates in overt diabetics. This paper questions the value of very tight control — the answer provided warrants consideration and verification in larger studies, because the point is central to management of the pregnant diabetic. Other considerations are that too tight control risks the harmful effects of hypoglycaemia (on the fetus) which itself is reported to be equally as harmful (to the fetus) as hyperglycaemia (*1, *2). In support of this an increased incidence of fetal growth retardation in strictly controlled diabetics has been noted (*3). The recently published perinatal mortality results (4%) in diabetes must be considered to be satisfactory, although argument continues with regard to the necessary incidence of Caesarean section and the optimal maturity for delivery, Another important area for future study is the value of low fat, high unrefined carbohydrate diet to improve glucose tolerance in diabetics (*4, *5) a consideration that may profoundly influence long‐term maternal prognosis, especially in gestational diabetics where complications of the disease (small vessel changes) are absent or less overt. *1. Abell, DA, Beischer NA. The effects of hypoglycaemia and hyperglycaemia on pregnancy outcome. ANZ J Obstet Gynaecol 1976; 16: 75–81. *2. Drew JD, Abell DA, Beischer NA. Congenital Malformations, Abnormal Glucose Tolerance, and Estriol Excretion in Pregnancy. Obst Gynecol 1978; 51: 129–132. *3. Harley G, Belfast. Personal communication. *4. Brunzell JD, Lerner RL, Hazard WR, Porte D Jnr, Beirman EL. Improved glucose tolerance with high carbohydrate feeding in mild diabetes. N Engl J Med 1971; 284: 521–524. *5. Nolan CJ. Improved glucose tolerance in gestational diabetic women on a low fat high unrefined carbohydrate diet. ANZ J Obstet Gynaceol 1984; 24: 174–177. Summary: Three tight regimens to maintain blood sugar values of 5.6 SI (group A), 5.6–6.7 SI (group B), and 6.7–8.9 SI (group C), were studied in 60 pregnant diabetic patients. The perinatal salvage rate was 96.6%. Maternal hypoglycaemia occurred only in group A. The group C regimen produced more complications than occurred in the other 2 groups. Very tight control of blood sugar is not necessary for successful management of diabetes in pregnancy and blood sugar value between 5.6–6.7 SI offers the best outcome.