BMJ 1998;316:550 (14 February)

Letters

Outcome of pregnancy in women with insulin dependent diabetes

Centralisation of care leads to better outcome

Editor–The finding of a persistently poor outcome of pregnancy in women with insulin dependent diabetes in two (northern) English regions is an important statement of the problem.1 2 Both studies provide figures and show outcomes that are no different from those widely reported in the past. Unfortunately, neither give evidence of any degree of centralisation of obstetric or diabetic care, with on-site neonatal intensive care, although this is a proved means of improving the outcome of pregnancy for diabetic mothers.3 The St Vincent declaration guidelines on the outcome of pregnancy, referred to in the accompanying editorial (p 263), are based on the Scandinavian reports held up as examples of good practice and state that "an interdisciplinary team should provide centralized diabetic pregnancy care in a hospital treating at least 20-30 cases a year. Pregnant diabetic patients should regularly visit the centre, before, during, and . . . [Full text of this article]


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Relevant Article

Outcomes of pregnancy in insulin dependent diabetic women: results of a five year population cohort study
I F Casson, C A Clarke, C V Howard, O McKendrick, S Pennycook, P O D Pharoah, M J Platt, M Stanisstreet, D van Velszen, and S Walkinshaw
BMJ 1997 315: 275-278. [Abstract] [Full Text]

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