[Results achieved on metabolic treatment of 90 pregnant women with manifest diabetes (author's transl)].

This paper concerns the treatment schedules employed and their outcome in 90 pregnancies in women with insulin-dependent clinical diabetes between 1962 and 1977. During the period 1962 to 1970, during which time diabetic control was still mostly carried out externally, the perinatal mortality rate (pnm) was 23.8%. As from 1971 the patients were put under control by the clinic as soon as possible on an interdisciplinary basis and the pnm dropped to 4.1%. The case history of these patients revealed that the pnm in previous pregnancies supervized elsewhere was 65%. No correlation was found between the pnm and the severity and duration of diabetes according to White's classification. Rigorous metabolic control is essential for an improvment in the pnm. This involves striving for mean blood glucose levels of under 100 mg% during the last trimester. Fetal weight gain above normal levels was sometimes detected by ultrasonic methods in spite of satisfactory metabolic regulation. The daily intake of carbohydrates should be reduced in these cases from 150-200 g to 100 g. Other important aspects include treatment of frequently-occurring complications (toxaemia, urinary infection, etc.), as well as measures to lower the rate of premature birth. The date of delivery was flexible and dependent on the response to metabolic control and the appearance of critical situations. On average, delivery took place at the end of the 38th week of gestation.