Endocrine Abstracts

JOINT3999

Introduction: In Morocco, pre-existing diabetes during pregnancy is a serious public health concern. In addition to placing a significant socioeconomic burden on patients, it is associated with an increased risk of complications.

Objective: Examining the epidemiological, clinical, and therapeutic aspects of pre-existing diabetes during pregnancy is the aim of our research. We also want to evaluate maternal-fetal morbidity and mortality, neonatal outcomes, and pregnancy progression.

Materials and Methods: A retrospective, descriptive study based on a review of clinical records of pregnant women with type 1 and type 2 diabetes, monitored at the Endocrinology, Diabetology, and Metabolic Diseases Department of the Hassan II University Hospital in Fez over a 13-year period, from January 2009 to September 2022.

Results: 319 women with pre-existing diabetes were included, of these, 24.1% had type 1 diabetes and 75.9% had type 2 diabetes. The average age of type 2 diabetes was 36.4 ± 5.45 years. The duration of diabetes was 43 ± 10.86 months on average. 5.8% of cases had degenerative consequences. The average pre-pregnancy HbA1c was 8.2% ± 2.6%, and 97.9% of pregnancies were unplanned. The average age of type 1 diabetes was 29.7 ± 6.29 years. 106 ± 62 months was the average duration of diabetes. 93.5% of pregnancies were unplanned, with an average pre-pregnancy HbA1c of 8.2% ± 3.1%. Insulin was used. In the first, second, and third trimesters, the average daily insulin dosage was 35.4 ± 2.9 IU, 39.9 ± 3.2 IU, and 47.9 ± 3.6 IU, respectively. Concerning maternal complications, among those with type 1 diabetes were urinary tract infections (12.3%), severe hypoglycemia (4.2%), ketoacidosis (13.3%), and gestational hypertension (7.8%). Urinary tract infections were the most common consequence among type 2 diabetes (15.5%), followed by ketoacidosis (2.8%). 58.3% of type 2 diabetes and 61.2% of type 1 diabetes had cesarean deliveries. Among the prenatal problems were hydramnios (29.8% vs. 30.1%), fetal abnormalities (9.4% vs. 6.7%), and macrosomia (37% in type 2 diabetics vs. 31.5% in type 1). 5.3% of cases had neonatal complications (4.4% in type 2 diabetics and 6.8% in type 1 diabetics). Of them, neonatal distress accounted for 29.2%, neonatal jaundice for 23.1%, and neonatal hypoglycemia for 20%.

Conclusion: Given these complications and their impact on both maternal and fetal health, whether in terms of vital or functional prognosis, we emphasize the need for a multidisciplinary approach.