Diabetes Mellitus and Pregnancy *

This report is a survey of all pregnancies complicated by diabetes delivered in a general hospital between 1921 and 1943. Omitted from consideration are 3 self-induced abortions and 10 early therapeutic abortions. Of the latter, one was performed because of previous toxemia of pregnancy (case 1, to be described), one because of pre-existent nephritis, one because of emaciation from long neglect of therapy, and the remainder chiefly for social and economic reasons. This leaves 31 pregnancies allowed to progress to or near term in 23 patients with diabetes. The diagnosis of diabetes was confirmed by the observation of unequivocal hyperglycemia in the postabsorptive state at some time in each case. The patients were all seen by one or more of the authors, and, with few exceptions, were under their general medical supervision before, during, and after the pregnancies. Diets in all cases contained approximately 80 grams of protein, at least 100 and usually 1 50 to 250 grams of carbohydrate, and fat sufficient to supply caloric needs. The aim of treatment was to insure utilization of the diet by prevention of any glycosuria. Insulin, when necessary, was used in the smallest doses which served to attain this end. The aim was not completely attained in many instances, as will be indicated later. Protamine insulin has been used in conjunction with regular or crystalline insulin in some of the more recent cases in accordance with our general practice.' Most of the patients were under our care long before the pregnancies, consulting us for many varied intercurrent events, of which pregnancy was only one. For this reason, there is considerable objective information concerning the health of these patients prior to pregnancy, and, more especially, concerning their vascular systems. The data are presented in Tables 1 and 2, with brief protocols in the appendix to supplement these data where necessary. The cases are tabulated in order of ascending age, first in the primigravida, then in the multigravida, since this arrangement makes certain correlations apparent on inspection.