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Clinical and epidemiological profile of diabetes mellitus in pregnancy, Isle of Youth, 2008.

INTRODUCTION
Diabetes in pregnancy threatens both maternal and neonatal health, with risks of lung immaturity, fetal macrosomia, dystocia and impaired maternal kidney function. Before insulin, diabetes resulted in maternal mortality rates of 30-50% and perinatal mortality rates of 50-60%. Global prevalence estimates vary by population, geographical area and diagnostic criteria. Diabetes accounts for some 90% of endocrine complications in pregnancy.


OBJECTIVES
Determine diabetes mellitus prevalence in pregnancy and characterize the population of diabetic women who gave birth in the Isle of Youth Special Municipality in 2008.


METHODS
A descriptive retrospective study was carried out from January to December 2008. Clinical records were reviewed of 180 diabetic women who gave birth on the Isle of Youth in 2008, their diagnosis based on WHO criteria modified by municipal health authorities. Study variables were: maternal age, nutritional status, glucose tolerance, gestational age at diagnosis, history of diabetes, and pregnancy outcome; as well as risk factors such as diabetes family history, pregnancy weight gain and comorbidities.


RESULTS
Overall prevalence (pregestational and gestational diabetes) among these cases was 17.3%; highest in the group aged ≥ 35 years. Gestational diabetes was more frequent (96.1% of cases) than pre-gestational diabetes. Multiparity (62.1%), a first-degree family history of diabetes mellitus (26.1%), excess weight before pregnancy (50%) and adequate weight gain during pregnancy (54.4%) were the most frequent conditions found. Among gestational diabetics, diabetes was most frequently detected at 20-28 weeks gestation (31.8%). Fetal macrosomia appeared in 4.4% of cases and a high percentage of deliveries were by Cesarean section (30%). There were no low Apgar scores or congenital abnormalities among neonates.


CONCLUSIONS
Despite using modified, more inclusive, WHO diagnostic criteria, the clinical and demographic characteristics of the population studied were comparable to those in other studies of diabetes in pregnancy, except for the low frequency of fetal macrosomia and absence of birth defects present in our study.