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Autonomic neuropathy in pregnancy of IDDM women

Objective. The autonomic neuropathy was recently recognised as a potential risk factor in pregnancy of IDDM diabetics. We wish to highlight a poorly recognised problem in the obstetric management of the diabetic mother. Study design. It was included 44 pregnant IDDM diabetics in the age of 20 to 35 with the minimum two years of diabetes. The normal population, e.g. 30 pregnant women without diabetes in the same age group, were evaluated, because there are no normal values for this population. Cardiovascular tests as well as structured clinical examination was monitored 3 times during pregnancy (once in each trimester). Cardiovascular tests were examined using ProSciCard system. The full battery of tests was performed and six basic tests were evaluated. HbA1c measured the diabetes regulation. Diabetic polyneuropathy were clinically assessed using Dyck's staging system. Results. The incidence of moderate and severe autonomic neuropathy in IDDM pregnant women was 11.4%. High perinatal morbidity and mortality associated with moderate and severe autonomic neuropathy, especially with gastropathy. Conclusion. The presence of moderate to severe symptomatic autonomic neuropathy in patients with IDDM is a relative contra-indication to pregnancy. If pregnancy is achieved then the patients should be monitored for the occurrence of significant vomiting.

insulin dependent diabetes mellitus; pregnancy; autonomic nerve system; diabetic neuropathy

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