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Holly L. Casele, MD; Steven A. Laifer, MD

Arch Intern Med. 1998;158:1321-1324.

Background  Although periconceptional glycemic control directly impacts perinatal outcome for pregestational diabetic women, these women still frequently enter pregnancy with suboptimal control of glycemia.

Objectives  To determine how frequently diabetic women enter pregnancy with suboptimal glycemic control and to identify factors associated with not achieving optimal periconceptual control of glycemia.

Patients and Methods  Pregestational diabetic women (n=55) who attended the Maternal Fetal Medicine Faculty Practice or the Resident Medical Complications Obstetric Clinic, Magee Women's Hospital, Pittsburgh, Pa, were administered a brief questionnaire pertaining to periconceptional education and control of glycemia. Levels of periconceptional hemoglobin A_1c were measured in all patients.

Results  Sixty-one percent of pregestational diabetic women presented for prenatal care with suboptimal control of their blood glucose levels (hemoglobin A_1c measurement, >0.08). Of the 55 diabetic women who participated in the questionnaire, 47 (86%) were under the care of a physician for their diabetes, 45 (82%) monitored their glucose level at least 3 times per day, 34 (60%) stated that they had been advised to plan a pregnancy, and 29 (53%) stated that they had planned their pregnancies. Women who had not been advised to achieve target hemoglobin A_1c levels were more likely to enter pregnancy with suboptimal control of their blood glucose levels (P=.02). Women who experienced prior complications with pregnancy were significantly more likely to enter pregnancy with suboptimal control of their blood glucose levels (P=.02).

Conclusions  Diabetic women frequently enter pregnancy with suboptimal control of glycemia. Women not advised to achieve target glucose or hemoglobin A_1c levels were more likely to enter pregnancy with suboptimal control of glycemia.

From the Division of Maternal Fetal Medicine, Northwestern University Medical School, Evanston Hospital, Evanston, Ill (Dr Casele), and the Department of Obstetrics, Gynecology, and Reproductive Sciences, the Division of Maternal Fetal Medicine, University of Pittsburgh Health Sciences Center, Pittsburgh, Pa (Dr Laifer).

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