Adverse pregnancy outcomes in women with diabetes-related microvascular disease and risks of disease progression in pregnancy: A systematic review and meta-analysis

Abstract

Background The rise in the global prevalence of diabetes, particularly among younger people, has led to an increase in the number of pregnant women with preexisting diabetes, many of whom have diabetes-related microvascular complications. We aimed to estimate the magnitude of the risks of adverse pregnancy outcomes or disease progression in this population. Methods and findings We undertook a systematic review and meta-analysis on maternal and perinatal complications in women with type 1 or 2 diabetic microvascular disease and the risk factors for worsening of microvascular disease in pregnancy using a prospective protocol (PROSPERO CRD42017076647). We searched major databases (January 1990 to July 2021) for relevant cohort studies. Study quality was assessed using the Newcastle–Ottawa Scale. We summarized the findings as odds ratios (ORs) with 95% confidence intervals (CIs) using random effects meta-analysis. We included 56 cohort studies involving 12,819 pregnant women with diabetes; 40 from Europe and 9 from North America. Pregnant women with diabetic nephropathy were at greater risk of preeclampsia (OR 10.76, CI 6.43 to 17.99, p < 0.001), early (<34 weeks) (OR 6.90, 95% CI 3.38 to 14.06, p < 0.001) and any preterm birth (OR 4.48, CI 3.40 to 5.92, p < 0.001), and cesarean section (OR 3.04, CI 1.24 to 7.47, p = 0.015); their babies were at increased risk of perinatal death (OR 2.26, CI 1.07 to 4.75, p = 0.032), congenital abnormality (OR 2.71, CI 1.58 to 4.66, p < 0.001), small for gestational age (OR 16.89, CI 7.07 to 40.37, p < 0.001), and admission to neonatal unit (OR 2.59, CI 1.72 to 3.90, p < 0.001) than those without nephropathy. Diabetic retinopathy was associated with any preterm birth (OR 1.67, CI 1.27 to 2.20, p < 0.001) and preeclampsia (OR 2.20, CI 1.57 to 3.10, p < 0.001) but not other complications. The risks of onset or worsening of retinopathy were increased in women who were nulliparous (OR 1.75, 95% CI 1.28 to 2.40, p < 0.001), smokers (OR 2.31, 95% CI 1.25 to 4.27, p = 0.008), with existing proliferative disease (OR 2.12, 95% CI 1.11 to 4.04, p = 0.022), and longer duration of diabetes (weighted mean difference: 4.51 years, 95% CI 2.26 to 6.76, p < 0.001) than those without the risk factors. The main limitations of this analysis are the heterogeneity of definition of retinopathy and nephropathy and the inclusion of women both with type 1 and type 2 diabetes. Conclusions In pregnant women with diabetes, presence of nephropathy and/or retinopathy appear to further increase the risks of maternal complications.

Trends in the Prevalence and Progression of Diabetic Retinopathy Associated with Hyperglycemic Disorders during Pregnancy in Japan

“…DR was associated with any preterm birth and preeclampsia. The risks of onset or worsening of DR were increased in women who were nulliparous, smokers, presented with existing proliferative disease, had more chronic diabetes [ 20 ]. Our results also show that hypertension, renal failure, eclampsia, caesarean section, and induced labor are general risk factors for DR.…”

Web-based interventions for pregnant women with gestational diabetes mellitus: a systematic review and meta-analysis protocol

“…GDM has been demonstrated to be closely associated with considerable maternal and neonatal short-term and long-term complications. 5 7 9 11 The traditional mode of GDM management is effective but requires intensive clinical input. 15 18 In recent years, web-based interventions have become increasingly popular in the field of GDM management due to making treatments more accessible and affordable.…”

“…GDM has been demonstrated to be closely associated with considerable maternal and neonatal short-term and long-term complications 5 7 9 11. The traditional mode of GDM management is effective but requires intensive clinical input 15 18.…”

“…It has been demonstrated that GDM is closely related to obstetrical problems at the time of delivery as well as subsequent perinatal morbidity. 5 6 The potential short-term impacts for mothers include increased risk of pre-eclampsia, polyhydramnios, shoulder dystocia, stillbirth and infectious complications. 7 Worse still, although GDM will resolve within a short period after delivery, it is an independent risk factor for many diseases.…”

Prevalence and Sociodemographic Profiles of Grand Multipara in Abu Dhabi, United Arab Emirates

“…The combined effects of higher maternal age and higher parity on overweight and obesity could explain the high prevalence of hypertension and diabetes among grand multipara [ 1 , 4 ]. The literature from many countries, including the UAE, revealed that chronic diseases (e.g., diabetes mellitus) are associated with adverse pregnancy outcomes [ 23 , 24 ]. For example, a systematic review and meta-analysis conducted by Relph et al showed mothers with uncontrolled diabetes mellitus were at greater risk of preeclampsia, preterm birth, perinatal death, congenital abnormality, small for gestational age, and admissions to NICU [ 23 ].…”