OBJECTIVE -The reported rate of preterm delivery in women with type 1 diabetes ranges from 22 to 45%, but the reasons are unclear. The purpose of this study was to identify factors associated with preterm delivery in these women. RESEARCH DESIGN AND METHODS-We studied the influence of maternal and diabetes-related factors on the occurrence of preterm delivery in 168 single pregnancies occurring in 127 women with type 1 diabetes. Women with spontaneous or indicated preterm delivery were compared with those who delivered after 37 weeks of gestation using polytomous logistic regression. Ն7% (7.5 [1.5-37.9]) at delivery were all associated with indicated preterm delivery. Preterm delivery was associated with significant neonatal morbidity as the risks for neonatal hypoglycemia and respiratory distress syndrome were increased by three-to sixfold compared with the reference group. RESULTSCONCLUSIONS -The rate of preterm delivery remains high in women with type 1 diabetes. Different factors were associated with spontaneous and indicated preterm delivery, respectively. Because poor glycemic control was a risk factor for both outcomes, part of preterm delivery might be preventable. Diabetes Care 27:2824 -2828, 2004R ecent surveys have shown that perinatal complications are still increased in women with type 1 diabetes (1-4). Particularly, the rate of preterm delivery ranged from 22 to 45% in women with type 1 diabetes, i.e., increased by four-to eightfold over the frequency of preterm delivery in nondiabetic single pregnancies (5-10). Preterm delivery is either spontaneous or indicated for maternal or fetal reasons. The rate of both spontaneous and indicated preterm delivery is increased in women with type 1 diabetes. Spontaneous preterm delivery, due to preterm labor or premature rupture of the membranes, has been associated with poor glycemic control (5,11) and urogenital infections (5). Indicated preterm delivery has been primarily related to the increased occurrence of preeclampsia in women with type 1 diabetes (6,9).However, in many previous studies, data on diabetes complications, preconception care, and glycemic control during pregnancy have not been systematically collected. The aim of the present study was to assess the factors that may be associated with spontaneous and indicated preterm delivery in a cohort of women with type 1 diabetes, all followed at the same institution according to a standardized protocol. A secondary objective was to determine whether risk factors for preterm delivery could be identified before or during early pregnancy and might lead to prevention. RESEARCH DESIGN ANDMETHODS -All women with type 1 diabetes and a single pregnancy who consecutively delivered after 22 weeks of gestation in the Department of Obstetrics and Gynecology, Cochin-Saint Vincent de Paul Hospital, between 1997 and were included in the study.Women of child-bearing age were informed about the need for preconception care. Preconception care included assessment of diabetes complications, review of dietary habits, int...

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