Persistently poor pregnancy outcomes in women with insulin dependent diabetes

BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7103.263 (Published 02 August 1997) Cite this as: BMJ 1997;315:263

Success in some countries shows that these can be reversed

  1. David Simmons, Senior lecturer in medicinea
  1. a South Auckland Academic Division, Middlemore Hospital, Otahuhu, Auckland 6, New Zealand

    Women with insulin dependent diabetes no longer “give birth astride of a grave.”1 By the time of the St Vincent declaration in 1989, with its goal of near normal pregnancy outcomes for diabetic women, non-randomised studies from specialist centres had clearly shown major reductions in fetal and neonatal loss down to 2-4%.1 2 At the time, Drury proclaimed that “malformations constitute the last bastion to be conquered” among pregnant women with insulin dependent diabetes.1 Non-randomised studies suggested that, with careful family planning and tight control of preconceptual glycaemia, even malformations could be reduced to near background rates.3 It is therefore disappointing that the first published papers on this target of the St Vincent declaration, reported in this week's BMJ (pp 275, 279), indicate no local improvement in the rate of either mortality or malformation.4 5

    Why is it that in these two studies of populations in England the declaration's goal …

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