الفهرس | Only 14 pages are availabe for public view |
Abstract INTRODUCTION It is well established that diabetes mellitus in pregnancy is associated with increased risk of fetal and neonatal mortality. For over 50 years numerous authorities have advocated that pregnant women with preexisting diabetes be managed by teams of specialized personnel, preferably in centers where high risk obstetric and neonatal service are available. Recently, reports from several diabetes centers have documented that with early, rigorous and coordinated perinatal management, perinatal mortality rates for pregnancies complicated by preexisting diabetes can be reduced to levels in the range of 35 to 46 per 1000 births (Gaube et al., 1977; Kitzmiller et al., 1978). These results, however, may not be indicative of the experience of the general pregnant diabetic population particularly of those women delivering outside of major medical centers. First, patients in diabetic centers may be atypical either because they are referred as a result of high risk status or because they live in proximity of teaching hospitals. Second, the outcomes 2 reported are undoubtedly due in large part to care by providers whose interest and expertise in the care of pregnant women with diabetes surpasses that of physicians who serve the majority of the general pregnant population. To establish estimates of the incidence of pregnancy complicated by preexisting maternal diabetes and to measure perinatal risks for an unselected population of pregnant diabetic women, a population based study of these pregnancies was undertook. |