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The British Survey of Diabetic Pregnancies

Congenital malformation of the fetus remains a major complication of diabetic pregnancy despite the dramatic fall in perinatal mortality in recent years. The reported incidence of major and minor malformations in women with established diabetes ranges from 6 to 10% (Soler 1976) compared with 2.1% in the general population (Ofice of Population Censuses and Surveys 1981). The current view is that organogenesis is disrupted by the hyperglycaemia of diabetes and studies in animals have confirmed the teratogenic effect of maternal hyperglycaemia (Baker et al. 1981). It is also common for pregnant women with established diabetes not to receive intensive supervision of their diabetes until near the end of or after the first trimester when organogenesis is complete. Nevertheless, the concept that the increased incidence of fetal malformations in women with diabetes is due to poor diabetic control lacks direct supporting evidence; one only has to examine the data of Miller et al. (1981), which showed that malformations can occur in association with relatively normal glycosylated haemoglobin values, to realize that the relation is not simple. The persistence of an increased risk of fetal malformation in women with diabetes led to the proposal that there should be a national survey of the outcome of diabetic pregnancies throughout the UK. In 1979 representatives from the Medical Services Study Group of the Royal College of Physicians met with others from the British Diabetic Association and the Royal College of Obstetricians and Gynaecologists to promote such a survey under the direction of Dr Lowy. The survey was designed to obtain information on the relation between the control of diabetes and the obstetric and paediatric outcome of the