Unraveling the Mystery of Perinatal Deaths in Diabetic Pregnancy

Diabetes concurrent with pregnancy is a high risk condition and is associated with an increased risk of prenatal mortality. Stillbirth is defined as fetal death after 20 weeks of gestation. Other terms for stillbirths include fetal death, intrauterine fetal death, fetal demise, intrauterine fetal demise. Stillbirth rate is 4-6 times and neonatal mortality is 2-4 times higher in diabetic than in non-diabetic pregnancies. The term prenatal mortality rate is defined as the number of stillbirths after 20 weeks of gestation and number of infant deaths up to 28 days of life [1]. In the pre-insulin era successful pregnancy was rare in women with pregestational diabetes with prenatal mortality rate as high as 65% [2]. However with advent of self-monitoring of blood glucose by glucometers, HbA1c, continuous glucose monitoring, insulin pens, pumps, availability of newer insulin analogues, improved perinatal care, including fetal surveillance techniques, ultrasonography and Doppler, timely labor induction and advanced neonatal care the rate of fetal death in diabetic women has reduced substantially. This article outlines the incidence, path physiology and measures to reduce the risk of stillbirth in diabetic pregnancies.