Diabetes during Labour: Types, Mode of Delivery and Fetal Outcome in Erbil Maternity Teaching Hospital

Shahla Karim Alaf

College of Medicine, Hawler Medical University  

A field study on 54 pregnant women during labor with pre gestational and gestational diabetes in
Erbil Maternity Teaching Hospital ,Erbil city , Kurdistan region Iraq from 1st of January to the 1st of
March 2005 was carried out to determine the types of diabetes, mode of delivery and neonatal out come .
Total deliveries in this period were 2891, making the rate of diabetes during labor 1.9%. Mean maternal
age was33.65±5.35 years, mean maternal weight was 79.50±13.5 kg, 3.7% of patients were primigraivid
while 57.41 % were grandmultiparus.63% of diabetic patients in our study were Gestational diabetes
while 37% were pregestational diabetes (Type 1 and Type 2 Diabetes).There was no statistically
significant correlations between the types of diabetes and maternal age, weight, and parity.61.1% of the
patients delivered by Caesarean Section (Emergency and Elective) while 29.6% of cases delivered
spontaneously vaginally .The most common indication for Caesarean Section was Cephalo pelvic
Disproportion .The perinatal mortality in the study group was 6 (2 macerated stillbirth, 2 fresh stillbirth
and 2 early neonatal deaths), there were 5cases (9.2%) of congenital fetal malformations (4 congenital
heart disease and one case of club foot (all were newborns of pregestational diabetic mothers).

Keywords: Gestational diabetes, pregestational diabetes, spontaneous vaginal delivery,
cephalopelvic disproportion, perinatal, congenital fetal malformations, congenital heart

1. Arthur T. Evavs, Margarita de Veciana, and Mahmoud M .Benbarka .Endocrine disorder during pregnancy .Manual of      obstetrics, 5th Jeremy Oats, Suzanne Abraham .Fundamentals of edition, 1995, 9,121-122. 
2. Philips AF, Dubin JW.Obstetrics and Gynecology. Diabetes in pregnancy. 2005,16, 135. 
3. World Health Organization .Expert Committee .Diabetes Mellitus Technical Report series .Geneva: WHO, 1980:646. 
4. Gunton, J.E., Hitchman, R,..Effects of ethnicity on glucose tolerance , insulin resistance and beta cell function in 223  women with an abnormal glucose challenge test during pregnancy.Aust.N.Z.J.Obstet.Gynecol. 2002, 41:182-186.  
5. Thomas R Moor, Robert K Zurawin, Francisco Talavera , Verno Smith, Mark cooper, Lee P Schulman. Diabetes Mellitus and  Pregnancy. Article Last Update: 2005. 
6. Galerneau F, Inzucchi SE. Diabetes mellitus in pregnancy. Obstet Gynecol, Clin North Am. 2004; 31(4):907-33. 
7. Jovanovic –Peterson L , Peterson CM, Reed GF, et al.Maternal Postprandial glucose levels and infant birth weight : the  Diabetes in Early Pregnancy Study. The National Institute of Child Health and Human Development-Diabetes in Early Pregnancy Study. Am J Obstet Gynecol. 1991; 164(1 pt 1): 103-11. 
8. Major CA, Hinny MJ, DE Veciana M, Morgan MA. The effects of carbohydrate restriction in patients with diet-controlled  gestational diabetes .Obstet Gynecol. Apr 1998; 91(4):600-4. 
9. HARISH M.SEHDEV.Medical Complications of Pregnancy. National Medical Series for Independent Study Obstetrics and Gynecology.5th edi.chapter 17; 180-182. 
10. Michael Maresh .Diabetes in Pregnancy .Progress in Obstetrics and Gynaecology 1998. 13 ,192, 
11. American College of Obstetrician and Gynecologists. Fetal Macrosomia .Practice Bulletin Number 22. 
12. Diana Hamilton –Fairly .Lecture notes: Obstetrics and Gynecology 2005.chapter 11, 147-150. 
13. Stuart Campbell, Christopher Lee's .Obstetrics by Ten Teachers 2000 .17th edition 16,250. 
14. Cypryk  k, Pertynska-Marczwska  M , Szymczak  W, Zawodniak-Szalapska M. Overweight and Obesity as common risk factors for gestational diabetes mellitus (GDM), perinatal macrosomy in offspring and type 2 diabetes in mothers.Przegl  Lek Journal.2005; 62(1): 3841.  
15. Donald W.M. Pearson, Alison Ross. Diabetes and Pregnancy, European Practice in Gynecology and Obstetrics 2004; 2:31. 
16. Solomn CG , Willete WC, Carey VJ , Rich-Edwards J, Hunter DJ ,Colditz GA  et al .A prospective study of pregravid determinants of gestational diabetes mellitus .JAMA 1 2002; 278(13):1078-1083.   
17. Sutherland HW, Fisher PM.Fetal loss and maternal glucose intolerance. A retrospective study .Padiatro Padol journal 1992; 17 (2): 279-86.  
18. American Diabetes Association. Gestational Diabetes Mellitus Position Statement.25 suppl 1.2002:S94-6. 
19. Gutierrez Gutierrez HI, Carrillo Ingiuez MJ, Pest Maria Ferreira M .Pregnant Diabetic Patients: Institutional experience .Ginecol Obstet Mex J .2006; 74(4) 187-92. 
20. Sheffield JS, et al. Maternal Diabetes Mellitus and Infant Malformations. Obstetrics and Gynecology, 2002, 100(5), part 1, 925-930.