Diabetes mellitus Typ1 und Schwangerschaft: Entwicklung von Morbiditäts- und Mortalitätskriterien 1990-2004 -eine Datenanalyse der Hessischen Perinatalerhebung (HEPE)

Since the St. Vincent declaration in the year 1989 with the objective to improve the quality of health care of pregnant diabetics in such a way that the morbidity and mortality risk of these women and their offspring is equal to the risk of healthy women, it was tried in many studies to measure the existing quality of health care on the basis of different risk parameters for maternal and infantile morbidity and mortality. These publications document furthermore an increased risk profile of pregnant diabetics and their offspring. There is no study in existence of the progress over a completely seized region, which gives an impression of the development of mortality, which mediates facts concerning mortality, morbidity and the various pregnancy and birth risks. The perinatal survey of the (German) state of Hessen (“Hessische Perinatalerhebung”, HEPE), which is a quality assurance measure for all inpatient facilities and obstetrics in the (German) state of Hessen, provides data for the present study of about 835.000 childbirth as well as about 848.000 newborns between 1990-2004. Women diagnosed with diabetes mellitus before conception are compared with the remaining pregnant women in the state of Hessen. It can be stated that the risk-group „pregnancy risk diabetes mellitus“ is within a risk cluster and that further risk of metabolic syndrome are immanent within this group. The hypothesis, taken up in this work title, that predominantly concerns pregnant woman with diabetes mellitus type 1, is therefore rejected. The study HEPE is not qualified to analyze the objectives of St. Vincent declaration. Examined cumulatively the mortality, morbidity, birth weight, pregnancy and birth risks of women (with preexisting diabetes) remain significant above the risk level of the remaining group of the ones without existing diabetes. During the analysis of the progress a declining tendency in many documented items is evident. However, it is impossible neither for perinatal mortality, nor for the necessity for a reanimation of the child, or for the Apgar-score to statistically secure this tendency. However, prove for a reduction of the frequency of pathological CTG- registrations or bad heart tones and a reduction of the frequency of gestosis and eclampsia is possible. The HEPE reveals a very high rate of cesarean sections, which among the control group is over 20% and in the risk- group is also over 40% and therefore lies considerably over the requirement of the WHO. Although the rate of secondary cesarean sections sinks, but is completely compensates with the increase of primary cesarean sections. There is a need for action for respective obstetric professional societies. Indications are presented that the supply structure in the past shows deficits regarding the statewide health care. The present supply structure has meanwhile revealed a lack of a missing definition of structural quality, so that the majority of health care institutions (medical practices specialized on diabetes) have less than four cases of pregnant diabetics per year. These indications explain the insufficient development of the results of the HEPE regarding a statistical secured improvement.