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OBJECTIVE—To evaluate perinatal outcome in pregnancies in women with type 1 and type 2 diabetes and the influence of preconception care 10 years after the St. Vincent’s declaration.RESEARCH DESIGN AND METHODS—A cross-sectional study was conducted in 12 perinatal centers in France in 2000-2001. The main investigated outcomes were perinatal mortality, major congenital malformations, and preterm delivery.RESULTS—Among 435 single pregnancies, 289 (66.4%) were from women with type 1 and 146 (33.6%) from women with type 2 diabetes. Perinatal mortality rate was 4.4% (0.7% national rate), severe congenital malformations rate was 4.1% (2.2% national rate), and preterm delivery rate was 38.2% (4.7% national rate). Preconception care was provided in 48.5% women with type 1 diabetes and in 24.0% women with type 2 diabetes. Women whose first trimester HbA1c was >8% had higher rates of perinatal mortality (9.2 vs. 2.5%; odds ratio 3.9; 95% CI 1.5–9.7; P < 0.005), major congenital malformations (8.3 vs. 2.5%; 3.5; 1.3–8.9; P < 0.01), and preterm delivery (57.6 vs. 24.8%; 1.4; 1.1–1.7; P < 0.005) than those with first trimester HbA1c CONCLUSIONS—Pregnancies in women with diabetes are still poorly planned and complicated by higher rates of perinatal mortality and major congenital malformations. Despite knowledge of the importance of intensified glycemic control before pregnancy, reaching the St. Vincent’s target needs further implementation in France.

To study the influence of energy and macronutrient intake on infant birthweight in women with gestational diabetes mellitus undergoing intensive management.This prospective study evaluated the impact of intensive management of gestational diabetes on maternal and fetal morbidity, and addressed the relationship between food intake and infant birthweight.Fifteen maternity hospitals in northern France.Ninety-nine women with gestational diabetes or gestational mild hyperglycemia diagnosed between 24 and 34 weeks of gestation were surveyed. After 1 was excluded because of a premature birth and 18 were excluded as underreporters, 80 women were included in the final analysis. Diet intake was assessed by a dietary history at the first interview, and by two 3-day diet records at the 3rd and 7th week after diagnosis.In a forward-stepwise regression analysis (controlling for maternal age; smoking; parity; prepregnancy BMI; pregnancy weight gain; gestational duration; infant sex; fasting and 2-hour postprandial serum glucose; insulin therapy; and energy, fat, protein and carbohydrate intake during treatment) infant birthweight was positively associated with gestational duration (beta = +0.34, P.002), and negatively with smoking (beta = -0.27, P.02) and carbohydrate intake (beta = -0.24, P.03). There were no large-for-gestational-age infants among women whose carbohydrate intake exceeded 210 g/day.For women with gestational diabetes undergoing intensive management, higher carbohydrate intake is associated with decreased incidence of macrosomia.These findings suggest that nutrition counseling in gestational diabetes must be directed to maintain a sufficient carbohydrate intake (at least 250 g per day), which implies a low-fat diet to limit energy intake. A careful distribution of carbohydrate throughout the day and the use of low-glycemic index foods may help limit postprandial hyperglycemia.

To evaluate the maternal and neonatal complications rates of mild gestational hyperglycaemia (MGH) compared to a control group in France.A systematic screening by a 50-g glucose challenge test was offered to all women between 24 and 28 weeks of gestation in 15 maternity units. If the 50-g glucose challenge test wasor = 7.2 mmol/l, a 100-g 3-h oral glucose tolerance test (OGTT) was performed. MGH (n = 131) was defined by one abnormal value on the 3-h OGTT (Carpenter and Coustan criteria). The control group (n = 108) was defined by a 50-g glucose challenge test below 7.2 mmol/l. Women with MGH received no treatment or specific advice during the pregnancy. Large for gestational age (LGA) was defined by a birth weight of at least the 90th percentile on French standard growth curves.Women with MGH were older than the controls (28.8 (5.8) vs. 27.0 (5.2); P0.05) and had a higher body mass index (24.8 (4.8) vs. 23.0 (3.9); P0.01). The rate of pregnancy-induced hypertension and Caesarean section were not different between the MGH and control group. The rate of LGA was significantly higher in the MGH group than the control group (22.1% vs. 11.4%; P0.05). After adjustment for confounding factors of macrosomia (pre-pregnancy body mass index27, maternal age35, multiparity and educational level), there was a persistent relationship between LGA and MGH (odds ratio 2.50; 95% confidence interval (1.16-5.40); P0.05). MGH was more frequently associated with adverse maternal and fetal outcome than in the controls (53.4% vs. 28.7%; P0.01).This study suggested that the increased rate of adverse maternal and fetal outcome, especially LGA, was associated with untreated mild gestational hyperglycaemia women compared to a control group. This link to lower degrees of hyperglycaemia during pregnancy is independent of confounding factors.