Diabetes Mellitus and Pregnancy: Influence of Maternal and Fetal Factors on Pregnancy Outcomes
Pregnancy in women with pre-gestational type 1 diabetes mellitus (TI DM) is associated with increased rates of fetal morbidity and mortality. Little data exists on pregnancy outcomes in patients with TI DM pregnancy in Ireland. In this thesis I present the results of one large audit and 9 smaller studies of 600 women with T1 DM attending at the combined diabetes-obstetric antenatal clinics from 1995-2006 in Dublin. Outcomes of pregnancy in patients with TlDM are compared with 142,498 control (non-diabetic) pregnancies delivered in the same hospitals for the same period. My studies demonstrate a fall in perinatal mortality rate in TI DM pregnancy in Dublin Hospitals since the study by Drury (1951-1984); perinatal mortality in my study is 3.3% compared to 7.4% in the study by Drury. This perinatal mortality rate is acceptable by international standards; however outcomes have not yet reached those of non-diabetic population. The St. Vincent Declaration with regards to the goal "to achieve pregnancy outcome in the diabetic woman that approximates that of the non-diabetic woman" has not been reached. Other maternal and fetal outcomes of TI DM pregnancy in our unit are similar to those reported in other studies. Intensive management of TI DM pregnancy in our unit was accomplished in combined endocrine obstetric clinics using complex (basal 1 bolus) insulin regimes. Strict glycaemic control of TI DM prior to and throughout pregnancy and during labour is essential to improve pregnancy outcomes.