This cross-sectional study, carried out at 12 French perinatal centers in the years 2000–2001, was intended to disclose whether pregnancy outcomes in diabetic women have improved a decade after defining the St. Vincent treatment goals, one of which is that outcomes in diabetic women should approximate those in nondiabetic women. These goals were formulated by the World Health Organization and International Diabetes Federation. The study included 289 women with type 1 diabetes and 146 with type 2 diabetes. Data were collected prospectively using the Obstetrical Quality Indicators and Data Collection database. Preconceptional care included optimizing insulin treatment and glycemic control, reviewing the diet, and intensifying capillary blood glucose self-monitoring. Gestational hypertension or preeclampsia developed in 19% of women with type 1 diabetes and 18% of those with type 2 diabetes. Perinatal mortality was 4.4%, compared with a national rate of 0.7%. Eight of the 19 perinatal deaths were associated with major congenital malformations, which occurred at a rate of 4.1% (national rate, 2.2%). The rate of preterm delivery, 38%, was much higher than the national figure of 4.7%. On multivariate analysis, delivery before 37 weeks gestation was associated with a first-trimester HbA1c greater than 8% (odds ratio [OR], 2.2), preexisting nephropathy (OR, 3.5), and gestational hypertension or preeclampsia (OR, 6.1). Birth weight exceeded 4000 g in 72 live-born infants. Cesarean section was performed in 59% of cases and instrumental extraction in 8%. A first-trimester HbA1c greater than 8%, recorded in 28% of the study population, correlated with greater perinatal mortality (OR, 3.9), major malformations (OR, 3.5), and preterm delivery (OR, 1.4). This level of HbA1c was more frequent in women who did not receive preconception care than in those who did (43.5% vs. 4%; OR, 18.5). In this study from France, pregnancy outcomes remain poor in women having type 1 or type 2 diabetes. The findings are comparable to those reported in France in 1986–1988. Prepregnancy glycemic control was more reliably achieved when women received prepregnancy care, but this apparently is not the complete answer.
Diabetes Care 2003;26:2990–2993