The St. Vincent targets for diabetes and pregnancy can be met

Abstract

Objective. To assess if the criteria for perinatal mortality and outcome of diabetic pregnancy had been met in a small and well-developed island society, Iceland. The aim of the St. Vincent declaration of WHO is that the same pregnancy outcome for diabetic and поп-diabetic women should be achieved.

Full Text

Objective. To assess if the criteria for perinatal mortality and outcome m diabetic pregnancy had been met in a small and well-developed island society, Iceland. The aim of the St. Vincent declaration of WHO is that the same pregnancy outcome for diabetic and поп-diabetic women should be achieved.

Methods: A 15-year audit of all women >16 weeks gestation with a preexisting or gestational diabetic state in a small but complete national population. The population of Iceland numbers 272.000 and nearly all women are cared for through one clinic, with telemedicine facilities to help monitor the pregnancies m association with local general practitioners and midwives.

Results: In 1981-1995, there were 64,988 babies delivered in the country, women diagnosed with niddm, iddm, and igt were 108 and had a total of 144 babies in 143 deliveries, there were two intrauterine deaths due to iugr in 1981 and 1983, one baby died aged 9 days from left ventricular hypoplasia in 1981 counting this baby the perinatal mortality was 21/1000, one mother died in 1987 at 34 weeks from sepsis secondary to paralysis after severe hypoglycemia. The baby survived and as well, but has learning difficulties, seven cardiac anomalies (4.9%) and 3 cardiomyopathies were diagnosed, with one death (in 1983) but others treated successfully. One anencephaly at 19 weeks was detected by ultrasound and the fetus aborted, no other serious maternal or fetal morbidity occurred. There were 61 deliveries to women with White Class A (43%). Of those wholly insulin dependent, 29 were Class В (35%), 20 Class C (24%), 13 Class D (22%), 1 Class E, 9 Class F (11%) and 5 Class R (6%). The vaginal delivery rate was 64%. Of these 2/3 were induced at 38-40 weeks.

Conclusions. It is possible to meet the aims of the St. Vincent declaration as shown by 0 (zero) perinatal mortality and little neonatal or maternal morbidity for the last 16 years. A centralized organization with intensified monitoring of glucose control, fetal growth and health is required along with education of the diabetic population.