DIABETES IN PREGNANCY
Diabetes Mellitus is rare in pregnancy, but when it does occur the
disease is fatal in three-fourths of the children, and it hastens the
death of the woman, according to the common opinion of obstetricians,
but this opinion is disputed. In making the diagnosis we must exclude
lactosuria and other pseudodiabetic conditions. A sugar reaction
which is often mistaken for the glycosuria of true diabetes is from
lactose in excessive milk secretion. This lactosuria is harmless.
Again, when women are taking tonics or cough mixtures containing
derivatives of wild cherry their urine may give a sugar reaction
from the phloridzin of the wild cherry. The phloridzin so acts on
the epithelium of the kidneys that it lets the blood-sugar escape
into the urine. Medical writers who report diabetes in large numbers
of pregnant women mistake these reactions for the reaction of true
glycosuria.
In the genuine diabetes of pregnancy there is a high mortality.
Offergeld,[200] in sixty cases, found that the women died within
two and a half years, and that 76 per cent. of the children were
lost. Diabetics commonly are sterile from atrophy of the uterus and
ovaries: in a series of 114 diabetic married women, Lacorché found
only seven pregnancies. In a third of such as do become pregnant
abortion or premature labor occurs. Coma happens in 30 per cent. of
these pregnancies, and it is almost always fatal. Delivery frequently
causes collapse, coma, or sudden death. The liver in any gestation
has more work than it has in the unimpregnated state, but a diabetic
liver is unfit for almost any normal function. If albuminuria is
found the prognosis becomes very bad. Diabetic women have poor
resistance against a tubercular infection. Half their children are
still-born, and 10 per cent. more die within a few days after birth
(many of these children are diabetic).
[200] _Archiv. f. Gyn._, bd. 86, n. 1.
There is some evidence of heredity in diabetes--it is likely "to
run in a family." Heiberg[201] reported one family in which five
of thirteen children had diabetes; in another, four of eight
children, the mother, two of the mother's brothers, and the maternal
grandfather had diabetes. In another, two brothers, the father, and
grandfather died of it. I know of a case where the only two sons and
the father in a family died of it. Heiberg did not find any essential
difference in the histology between the hereditary cases and those
which were not hereditary.
[201] _Deutsche medizinische Wochenschrift_, xlii, 9.
Joslin[202] reported seven cases of diabetes associated with
pregnancy. Four of the seven are now dead, one by suicide, one from
uremia, one from coma, one from tuberculosis. Of the three living one
is in good condition, one is not well and she has lost two of three
children, and one is very ill with diabetes. In persons beyond middle
age diabetes with proper treatment may go on for from ten to fifteen
years before it is fatal, but it quickly kills young patients. A
young woman at the marriageable age who has diabetes will die anyhow
in two or three years, and if she marries and becomes pregnant she
will die very probably in her first pregnancy.
[202] _Boston Medical and Surgical Journal_, November 25, 1915.
When the child is viable, and the diabetic mother shows albuminuria,
progressive weakness, or diacetic acid in marked quantity, it may
be necessary to perform therapeutic abortion; but if this is done
no anesthetic may be used, and great precautions should be taken to
avert physical and mental shock. Even ergot acts badly with these
cases. The last sacraments should be given in good time, especially
if coma threatens. When labor begins in a diabetic and everything
appears to be normal the sacraments should be given, because there is
always danger of sudden collapse and death.