Endocrine Abstracts

The work was initiated to study peculiarities of pregnancy in patients with prepubertal onset of type 1 diabetes mellitus (T1DM).

We examined 22 patients with prepubertal onset of T1DM. Glycemia and HbA1c levels were measured to assess carbohydrate metabolism. All patients were examined in compliance with protocol of management for patients with pre-gestational diabetes.

Mean age of the examinees, primagravidas, was 21.4±4.7, the disease onset age and duration being 10.8±4.7 and 12.8±4.5 respectively. Pre-gestational, gestational and post-gestational HbA1c was 8.7±1.3, 6.72±1.4 and 8.6±1.4% respectively, that is, as it can be seen, reduced through pregnancy. 22 patients received intensive basal-bolus therapy with recombinant human insulin, daily dose requirement changing by gestational age. Thus, daily doses in the first and second trimesters were 45.6±12.0 and 49.6±14.6 U/d, respectively, the one after delivery being 47.6±9.8 U. Hypoglycemic episodes were registered almost in all examinees two to three times a week in the first half of pregnancy, severe hypoglycemia being observed in three patients, the severest one through coma being registered in one patient. As to vascular complications, diabetic retinopathy of various degrees was found in 13 patients (59%), IV–V degree diabetic nephropathy being found in four, one woman having I degree chronic kidney deficiency. Despite contraindications to pregnancy prolongation in patients with IV–V degree diabetic nephropathy and having I degree chronic kidney deficiency, the pregnancies were not terminated. Diabetic nephropathy was found progressing, but transient and resolving in 6 months after delivery. As to pregnancy outcomes, therapeutic abortion was performed in four patients, due to morning sickness in one woman and to deterioration of the kidneys in three. Cesarean section was performed at various gestational ages in 16 (88.8%), at 34–35 weeks in four patients, at 36–37 weeks in six women, at 38–39 weeks in another six. Natural delivery was performed in two patients at 38–39 weeks.

Prepubertal DM onset poses high risk of complications in pregnancy. Risk of unfavorable pregnancy outcome is the highest one upon prolongation of pregnancy with contraindications.