The child of the diabetic woman.

Over a century ago Bennewitz (1828), when delivering a diabetic woman, observed that the giant foetus whose head had been born but whose shoulders were stuck fast 'seemed anxious and sighed with a clear voice'. In this depressed state the infant died, as so many of his kind have done since. Pregnancy complicating diabetes and the development of children born to diabetic women became problems only with the development of insulin. Before the dawn of the insulin era diabetes mellitus was associated with female infertility, possibly as a consequence of poor nutrition (Sinden and Longwell, 1949), and when pregnancy did occur the foetal mortality ranged from 40% (Duncan, 1883) to 70% (Eshner, 1907). With insulin, however, the infertile diabetic woman is now exceptional in the extensive experience of White (1952), and Stevenson (1956) found that in his Belfast series 70% were pregnant within one year of marriage and that over 90% were pregnant within two years. Although maternal mortality in diabetic pregnancy has been almost entirely eliminated, a distressing foetal loss persists. Until recently pre-viable abortions were included in the over-all foetal mortality figures. No evidence exists, however, to prove that abortions are any commoner among diabetic than among non-diabetic women (Peel and Oakley, 1950). A figure of 6X4% found by Pedowitz and Shlevin (1955) was well within the normal range in their experience, 10% of abortions were reported by Stevenson (1956), and Barns and Morgans (1949) discovered a diabetic abortion rate of 10 900 and a non-diabetic rate of I11 80. Because of this only viable foetal loss rates are customarily compared. The perinatal mortality for all booked pregnancies at the Simpson Memorial Maternity Pavilion has been less than 40 in 1,000 births in recent years, and this contrasts with the figure of 166 in 1,000 births