[The course of pregnancy and fetal outcome in diabetic patients with anamnestic fetal death].

Of 116 pregnant patients with diabetes mellitus type 1 or gestational diabetes, 12 (10.3%) had previously suffered stillbirth, while in four (3.4%) cases spontaneous abortion after the 6th month had occurred. In these 16 cases, we examined the mean daily blood glucose concentration, glycosylated hemoglobin (HbA1c), fructosamine as well as glucose and albumin elimination via urine. These control data on carbohydrate metabolism were correlated with the intensity of gestational monitoring in relation to course of pregnancy and neonatal morbidity and/or mortality. In addition, we retrospectively analyzed the cause of prior intrauterine death. In six of eight cases evaluable, we could hereby demonstrate disturbed carbohydrate metabolism. Pregnant women with diabetes mellitus type 1 were hospitalized twice as often (on average four times) as patients with gestational diabetes (2.1 admissions on average). While five of seven type 1 diabetics were primarily admitted prior to the 20th week of gestation, the majority of gestational diabetics (7/9) were first examined by qualified medical personnel trained in the care of gestational diabetes after the 28th week of gestation. Two of nine were first diagnosed post partum. 13 of 14 patients with prepartally known diabetes demonstrated mean blood glucose values under 110 mg/dl. While one of the two patients with postpartally diagnosed diabetes suffered stillbirth once again, the other had to be delivered by emergency C-section because of fetal distress (pH art. 7.08). Our results show that adequate monitoring of carbohydrate metabolism and proper care of diabetic pregnant women can lower obstetrical/neonatal risks to more acceptable levels, especially in those patients who have had stillbirth in their prior medical history.