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BMJ No 7103 Volume 315 Papers - Abstracts Saturday 2 August 1997
Outcomes of pregnancy in insulin dependent diabetic women:
results of a five year population cohort study
Outcomes of pregnancy in insulin dependent diabetic women: results of a five year population cohort studyI F Casson, C A Clarke, C V Howard, O McKendrick, S Pennycook, P O D Pharoah, M J Platt, M Stanisstreet, D van Velszen, S Walkinshaw See editorial by Simmons and paper (abstract only) p 279 AbstractObjective: To monitor pregnancies in women with pre-existent insulin dependent diabetes for pregnancy loss, congenital malformations, and fetal growth in a geographically defined area of north west England.Design: Population cohort study. Setting: 10 maternity units in Cheshire, Lancashire, and Merseyside which had no regional guidelines for the management of pregnancy in diabetic women. Subjects: 462 pregnancies in 355 women with insulin dependent diabetes from the 10 centres over five years (1990-4 inclusive). Main outcome measures: Numbers and rates of miscarriages, stillbirths, and neonatal and postneonatal deaths; prevalence of congenital malformations; birth weight in relation to gestational age. Results: Among 462 pregnancies, 351 (76%) resulted in a liveborn infant, 78 (17%) aborted spontaneously, nine (2%) resulted in stillbirth, and 24 (5%) were terminated. Of the terminations, nine were for congenital malformation. The stillbirth rate was 25.0/1,000 total births (95% confidence interval 8.9 to 41.1) compared with a population rate of 5.0/1,000, and infant mortality was 19.9/1,000 live births (5.3 to 34.6) compared with 6.8/1,000. The prevalence of congenital malformations was 94.0/1,000 live births (63.5 to 124.5) compared with 9.7/1,000 in the general population. When corrected for gestational age, mean birth weight in the sample was 1.3 standard deviations greater than that of infants of non-diabetic mothers. Infants with congenital malformations weighed less than those without. Conclusion: In an unselected population the infants of women with pre-existent insulin dependent diabetes mellitus have a 10-fold greater risk of a congenital malformation and a fivefold greater risk of being stillborn than infants in the general population. Further improvements in the management of pregnancy in diabetic women are needed if target of the St Vincent declaration of 1989 is to be met. Broadgreen Hospital, School of Biological Sciences, Fetal
and Infant Pathology, Department of Public Health, Liverpool Women's
Hospital, Correspondence to: Dr Platt.
Prospective population based survey of outcome of pregnancy in diabetic women: results of the Northern Diabetic Pregnancy Audit, 1994Gillian Hawthorne, S Robson, E A Ryall, D Sen, S H Roberts, M P Ward Platt on behalf of the Northern Diabetic Pregnancy Audit See editorial by Simmons and paper (abstract only) p 275 AbstractObjective: To determine whether the St Vincent declaration (1989) target of diabetic pregnancy outcome approximating non-diabetic pregnancy outcome is near to being achieved.Design: Prospective collection of population based information on pregnancies in women with diabetes from all participating hospitals. Setting: District general and teaching hospitals of the former Northern region. Subjects: 111 diabetic women booking with pregnancy during 1 January to 31 December 1994. Main outcome measures: Diabetic control, perinatal mortality rate, fetal abnormality rate. Results: The perinatal mortality rate was 48/1,000 for diabetic pregnancies compared with 8.9/1,000 for the background population (odds ratio 5.38; 95% confidence interval 2.27 to 12.70) and the neonatal mortality rate was 59/1,000 compared with 3.9/1,000 (15.0; 6.77 to 33.10). Two late neonatal deaths were due to congenital heart defects. Six per cent of all fetal losses (6/109 cases) were due to major malformations. The congenital malformation rate was 83/1,000 compared with 21.3/1,000 (3.76; 2.00 to 7.06) in the background population. Conclusion: Diabetic pregnancy remains a high risk state with perinatal mortality and fetal malformation rates much higher than in the background population. Hartlepool General Hospital, University of Newcastle upon Tyne, North Tees General Hospital, Diabetes Resource Centre, Royal Victoria
Infirmary, Correspondence to: Dr Hawthorne.
Long term effect of calcium supplementation during pregnancy on the blood pressure of offspring: follow up of a randomised controlled trialJosé M Belizán, José Villar, Eduardo Bergel, Alicia del Pino, Susana Di Fulvio, Silvia V Galliano, Cristina Kattan AbstractObjective: To explore the long term effect of calcium supplementation during pregnancy on the offspring's blood pressure during childhood.Design: Follow up of a population enrolled in a double blind, randomised, placebo controlled trial. Setting: Perinatal research unit, World Health Organisation's collaborative research centre. Subjects: 591 children at a mean age of 7 years whose mothers were randomly assigned during pregnancy to receive 2 g/day of elemental calcium (n=298) or placebo (n=293). Main outcome measures: Mean blood pressure and rate of high blood pressure of children. Results: Overall, systolic blood pressure was lower in the calcium group (mean difference -1.4 mm Hg; 95% confidence interval -3.2 to 0.5) than in the placebo group. The effect was found predominantly among children whose body mass index at assessment was above the median for this population (mean difference in systolic blood pressure -5.8 mm Hg (-9.8 mm Hg to -1.7 mm Hg) for children with an index g17.5 and -3.2 mm Hg (-6.3 mm Hg to -0.1 mm Hg) for those with an index of g15.7 to 17.5). The risk of high systolic blood pressure was also lower in the calcium group than in the placebo group (relative risk 0.59; 0.39 to 0.90) and particularly among children in the highest fourth of body mass index (0.43; 0.26 to 0.71). Conclusion: Calcium supplementation during pregnancy is associated with lower systolic blood pressure in the offspring, particularly among overweight children. Centro Rosarino de Estudios Perinatales, José M Belizán, director Eduardo Bergel, statistician Alicia del Pino, field director Susana Di Fulvio, research nurse Silvia V Galliano, biologist Cristina Kattan, research nurse UNDP/UNFPA/WHO/World Bank Special
Programme of Research, Correspondence to: Dr J Belizán
CLAP/PAHO/WHO, belizanj@clap.edu.uy
Effect of fundholding on waiting times: database studyBernard Dowling AbstractObjectives: To determine whether fundholding patients have shorter waiting times for surgery than non-fundholding patients and to establish if any such differences resulted from practices attaining fundholding status.Design: Comparison of waiting times of fundholding and non-fundholding patients for elective surgery covered by the fundholding scheme at four providers over four years. Comparison of the waiting times for patients of practices in their last year outside and first year inside the fundholding scheme with those for patients of practices remaining non-fundholding. Setting: West Sussex. Subjects: Over 57,000 patients on the elective waiting list who had operations purchased by a health authority or fundholding practice during 1992-6. Patients with booked or planned elective admissions were excluded. Main outcome measures: Waiting times for patients of fundholding and non-fundholding patients. Results: Patients of fundholding practices had significantly shorter waiting times than those of non-fundholders for all four providers and over all four years. Waiting times for patients did not fall until the year that the practices joined the fundholding scheme. Conclusions: Fundholding shortens waiting times. This may be because purchasing of elective surgery is best done at a practice level or because fundholding practices are funded overgenerously.
Department of Social
Policy and Administration,
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