Endocrine Abstracts

Introduction: Diabetic pregnancy is a high-risk pregnancy requiring a multidisciplinary approach and close monitoring to prevent maternal-fetal complications. Our study objective was to determine the diabetic pregnancies outcome of in order to improve their management.

Patients and methods: A descriptive retrospective study including 144 patients with diabetic pregnancy followed at the Endocrinology-Diabetology service between January 2016 and September 2017. Data collection was done from medical records. The statistical analysis was done by SPSS. The parameters were studied: age, diabetes type, obstetric history, pre-gestational BMI, weight gain during pregnancy, pre-conceptional HbA1c, for gestational diabetes the term of pregnancy at the time of the discovery and the methods of detection, treatment adopted and the degree of glycemic control, degenerative complications and obstetric complications.

Results: The study included 144 patients with an average age of 31,9ans, 32% had gestational diabetes and 68% pre-gestational diabetes. BMI pre-gestational average was 29.27 kg/m² with an average weight gain of 8 kg. Physical activity was performed in 34% of patients. Regarding gestational diabetes, gestational age through discovery was 20 weeks of gestation, discovered during a routine screening in 84.7% of patients and clinical signs in 13% of the cases. For screening methods, fasting glucose was requested by 67.3% against 26% for the 75g OGTT. Regarding the pre-gestational diabetes, 25.7% of patients had type 1 diabetes and 42.3% type 2 diabetes with a mean diabetes duration of 6 years and a mean HbA1c of 8.3%. Retinopathy was present in 22.4% of patients and nephropathy in 4%. For treatment, 80.5% of patients were on insulin and 19.5% in lifestyle and diet. Glycemic control was perfect in 56.3% of patients. Regarding obstetric complications we observed: gestational hypertension in 11.8%, preeclampsia at 4.8%, macrosomia in 8.4%, a preterm labor in 3.5%, malformations in 2%, hydramnios in 2%. The arrested pregnancies were observed in 3.5% of the studied cases.

Discussion: As clearly demonstrated our study, diabetic pregnancy remains a challenge for both the patient and for the health care team given the high number of maternal-fetal complications and the management of difficulty that requires collaboration between diabetologist obstetrician and gynecologist.