Management of the pregnant diabetic patient--are the pundits right?

Many authorities are currently suggesting specific strategies for optimal obstetrical management of pregnant diabetic patients which involve early admission, frequent monitoring and a high Caesarean section rate. The author suggests that a more conservative approach may be indicated. In support of this contention, he cites from his personal experience of managing over 1,000 diabetic pregnancies during the past 34 years. As there were no therapeutic abortions, the series is consecutive and unmodified. There were no maternal deaths, and the perinatal loss during the 34-year period was 7.4%. In the years 1979-1984 the perinatal loss in 285 viables was 4.5%, and the Caesarean section rate was 25.9%. In 87 primigravidae, the Caesarean rate was 31%.