Normalization of pregnancy outcome in pregestational diabetes through functional insulin treatment and modular out-patient education adapted for pregnancy K. Howorka, J. Pumprla, M. Gabriel, A. Feiks*, C. Schlusche, C. Nowotny*, E. Schober², T. Waldhoer³ and M. Langer* Abstract Aim To investigate whether modular out-patient group education for ¯exible, Functional Insulin Treatment (FIT) adapted for pregnancy can eliminate diabetes-associated neonatal complications in pregestational diabetes. Research design and methods Outcome analysis of the modular out- patient group education and FIT based on separate insulin dosages for fasting, eating or correcting hyperglycaemia in 76 consecutive pregnancies (in 20 cases ®rst after conception) of 59 patients with pregestational diabetes (Type 1 diabetes, n = 54). Controls: (a) diabetic pregnancies: historical controls; (b) non-diabetic pregnancies: retrospective case- controlled study; (c) population-based data of all Austrian newborns registered within the respective time period. Results HbA 1c of 113 6 18% of mean value (= 100%) of non-diabetic, non- pregnant population (103 6 14% during the last pregnancy trimester), and self-monitored blood glucose of 5.6 6 0.7 mmol/l (5.3 6 0.7 mmol/l during the last trimester) was achieved throughout all FIT pregnancies. Severe hypoglycaemia occurred in 14 pregnancies. The gestational age at delivery was 39.2 6 1.5 weeks (four cases (5.4%) < 37 weeks) with a birth weight of 3305 6 496 g. Four newborns (5.3%) were above the 90th, and nine (11.8%) below the 10th percentile for weight of reference population-based data. Hypoglycaemia was recorded in six newborns (8%). Malformations were found in two infants whose mothers booked for diabetes FIT education only after conception. The caesarean delivery rate was 25%. In comparison with historical diabetic pregnancy controls we demonstrated a reduction in major complications, and compared with non-diabetic women, a lowering of diabetes-related neonatal complication rates to general population levels. Conclusions Structured, comprehensive, modular out-patient group education promoting self-choice of insulin dose for ¯exible, normal eating prior to conception normalizes pregnancy outcome in diabetes. Diabet. Med. 18, 965±972 (2001) Keywords functional insulin treatment, macrosomia, pregestational diabetes, pregnancy outcome, structured group education Correspondence to: Professor Kinga Howorka MD, Lactation Consultant IBCLC, Institute of Biomedical Engineering and Physics, Institute of Public Health, University of Vienna, Allgemeines Krankenhaus, Leitstelle 4L, Wa È hringer Gu È rtel 18±20, A 1090 Vienna, Austria. E-mail: k.howorka@bmtp.akh-wien.ac.at Research Group Functional Rehabilitation and Group Education, Institute of Biomedical Engineering and Physics, Institute of Public Health, *Departments of Obstetrics and Gynaecology, ²Department of Paediatrics and ³Department of Epidemiology, Institute of Cancer Research, University of Vienna, Vienna, Austria Accepted 1 July 2001 ã 2001 Diabetes UK. Diabetic Medicine, 18, 965±972 965