Pregnancy Outcome in Maturity Onset Diabetes at Young Age (MODY)

EDITORIAL COMMENT: The point of this paper is that the authors wish to classify separately those patients aged less than 25 years known to be diabetic before the onset of pregnancy, who when not pregnant can be managed without insulin — presumably these patients can maintain normal blood sugar levels by diet alone when not pregnant. The authors have not explained why age is a criterion for classification. In other words the MODY group of diabetics are a subgroup of noninsulin dependent diabetics (type 2) who previously have been divided into nonobese and obese groups. The 1978 update of White's classification of pregnant women with diabetes has 15 categories and ‘its increasing complexity may have impaired its usefulness’ 1 . This warning is quoted so that we do not become distracted front the principles of obstetric management of diabetics: (1) prepreghancy counselling with stabilization of blood glucose levels before conception (2) good pregnancy control (3) monitoring of fetal condition in late pregnancy (oestriol assay, cardiotocography, ultrasonography) and (4) timing of delivery according to maternal and fetal condition. Unless obstetric complications dictate earlier intervention, pregnancy is allowed to go to full term (40 weeks). If insulin is required we favour induction of labour at 38 weeks' gestation after amniocentesis for estimation of the L/S ratio; before any elective induction the L/S ratio should be measured if there is doubt about fetal maturity.1 Williams Obstetrics 17th Edition. Prichard JA, MacDonald PC, Gant NF, Norwalk, Conn; Appleton‐Century‐Crofts 1985; p 599.Summary: Diabetes mellitus is not a single disease, but rather a syndrome comprised of a variety of diseases characterized by hyperglycaemia. Indeed it has a heterogeneous nature. Maturity Onset Diabetes of the Young or MODY is an unusual, mild type of hyperglycaemia, which develops in young women, (below the age of 25), who do not require insulin. This study describes 10 pregnancies in MODY women, who are compared to a group of patients with insulin‐dependent diabetes mellitus (IDDM), a group with gestational diabetes, and a control group of normal, healthy pregnant women. Our group of pregnant MODY patients proved to have an intermediate form of diabetes, more severe than gestational diabetes and yet not as severe as insulin‐dependent diabetes mellitus. Mean duration of diabetes was shorter and mean daily insulin requirement (during pregnancy) was lower among MODY patients in comparison to IDDM gestants. Moreover the frequency of maternal complications and Cae‐sarean deliveries in MODY patients were lower than in the IDDM group, but higher when compared to the gestational diabetes group.