Enhancement of Fetal Survival in Pregnancy With Diabetes

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EFFORTS to reduce maternal mortality and morbidity in the pregnant woman with diabetes mellitus have been rewarded with gratifying results throughout the world, yet the associated fetal mortality has not been correspondingly reduced. With close observation and early vigorous treatment, maternal complications such as acidosis and preeclampsia are either preventable or less threatening than formerly, with the result that maternal mortality among women with diabetes has been reduced from 50 percent in the days before insulin, to nearly zero.1 Although the rate of fetal survival has improved during this time, mortality rates of from 10 to 50 percent are still reported.1 During a three-year period (July 1, 1959, through June 30, 1962) the fetal mortality among 390 diabetics in the Cleveland area was 21.5 percent.2 During this same period, 19 babies were born to 14 diabetic mothers at the Cleveland Clinic Hospital, with one fetal death, or a fetal mortality rate of 5.2 percent.

The purpose of this report is to present the principles of management of diabetes and pregnancy, and of the newborn, which have been carried out in this group of 14 diabetic patients and their infants at the Cleveland Clinic. The cooperative efforts of three specialties are involved—obstetrics, endocrinology and metabolism, and pediatrics—and we are encouraged by the favorable results.

Obstetric Management

Among diabetic pregnant women, the incidence of preeclampsia, stillbirth, and other complications of pregnancy is high; therefore, a careful history of prior pregnancies is taken at the time of the initial examination of . . .



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