Preconceptual care for women with diabetes

Maternal complications Early in pregnancy, women with diabetes have an increased rate of abortion (Lorber, Before the discovery of insulin, few women with diabetes became pregnant. Among those who did, the maternal mortality rate was 50% with minimal chance of a live fetus (Parker, 1996). By the late 1930s the perinatal mortality rate had decreased to 40%. Perinatal mortality was thought to be due to diabetic ketoacidosis, late intrauterine death and prematurity (Gregory and Tattersall, 1992). Even in 1970, the textbooks were painting a bleak outlook for diabetic women hoping to become pregnant. The fetal mortality rate was 20% (Parker, 1996). As the number of live babies born increased, a relative increase in the incidence of congenital abnormalities was seen (Tattersall and Gale, 1990). Major congenital abnormalities remain the leading cause of death and morbidity in babies of diabetic mothers (Kitzmiller et al, 1996). The incidence of fetal abnormalities in the babies of diabetic mothers has now decreased to about 5% (Kellener, 1994), compared with 2% in the general population. This is possibly due to improvements in health care, knowledge and fetal monitoring.