ATLANTIC DIP: Pregnancy Outcome for Women With Pregestational Diabetes Along the Irish Atlantic Seaboard

Dunne, Fidelma; Avalos, G; Durkan, Meave; Mitchell, Yvonne; Gallacher, T; Keenan, Marita; Hogan, Marie C.; Carmody, Louise; Gaffney, G

doi:10.2337/dc09-1118

Cited by 66 publications

(65 citation statements)

References 9 publications

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“…This is consistent with other studies that continue to show elevated perinatal mortality rates in women with pre-GDM captured past 2003 (13,14,32). Two studies that looked at the trend over time showed a nonsignificant decline in stillbirths/perinatal mortality (13,14).…”

Section: Discussionsupporting

confidence: 91%

Trends in Incidence of Diabetes in Pregnancy and Serious Perinatal Outcomes: A Large, Population-Based Study in Ontario, Canada, 1996–2010

et al. 2014

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OBJECTIVEWomen with diabetes in pregnancy have high rates of pregnancy complications. Our aims were to explore trends in the incidence of diabetes in pregnancy and examine whether the risk of serious perinatal outcomes has changed. RESEARCH DESIGN AND METHODSWe performed a population-based cohort study of 1,109,605 women who delivered in Ontario, Canada, between 1 April 1996 and 31 March 2010. We categorized women as gestational diabetes (GDM) (n = 45,384), pregestational diabetes (pre-GDM) (n = 13,278), or no diabetes (n = 1,050,943). The annual age-adjusted rates of diabetes in pregnancy were calculated, and rates of serious perinatal outcomes were compared between groups and by year using Poisson regression. RESULTSThe age-adjusted rate of both GDM (2.7-5.6%, P < 0.001) and pre-GDM (0.7-1.5%, P < 0.001) doubled from 1996 to 2010. The rate of congenital anomalies declined by 23%, whereas the rate of perinatal mortality did not change significantly. However, compared with women with no diabetes, women with pre-GDM and GDM faced an increased risk of congenital anomalies (relative risk 1.86 [95% CI 1.49-2.33] and 1.26 [1.09-1.45], respectively), and perinatal mortality remained elevated in women with pre-GDM (2.33 [1.59-3.43]). CONCLUSIONSThe incidence of both GDM and pre-GDM in pregnancy has doubled over the last 14 years, and the overall burden of diabetes in pregnancy on society is growing. Although congenital anomaly rates have declined in women with diabetes, perinatal mortality rates remain unchanged, and the risk of both remains significantly elevated compared with nondiabetic women. Increased efforts are needed to reduce these adverse outcomes.Diabetes in pregnancy is becoming an increasingly growing concern as the prevalence of diabetes continues to rise (1). Women with diabetes who become pregnant have an increased risk of pregnancy complications (2-7), including serious perinatal outcomes such as stillbirth, perinatal mortality, and major congenital malformations. Hyperglycemia in the period around conception and the first weeks

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Section: Discussionsupporting

confidence: 91%

Trends in Incidence of Diabetes in Pregnancy and Serious Perinatal Outcomes: A Large, Population-Based Study in Ontario, Canada, 1996–2010

et al. 2014

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“…Established in 2006 following approval from the local ethics board, one of its aims is to determine the prevalence of hyperglycaemia in pregnancy and the associated short-and long-term maternal and fetal outcomes [8,9]. Pregnant women whose last menstrual period occurred between September 2006 and March 2009 were eligible to participate in Atlantic DIP.…”

Section: Methodsmentioning

confidence: 99%

Atlantic Diabetes in Pregnancy (DIP): the prevalence and outcomes of gestational diabetes mellitus using new diagnostic criteria

et al. 2011

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“…The Atlantic Diabetes in Pregnancy (Atlantic DIP) partnership was set up in 2005 and serves a population of 500 000 in five regional centers along the Irish Atlantic seaboard, with 11 000 deliveries annually, covering a geographical area of 7338 square miles (8). This partnership advocates universal screening for GDM by a 2 h 75 g oral glucose tolerance test (OGTT) at 24-28 weeks gestation using International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria.…”

Section: Methodsmentioning

confidence: 99%

“…All women diagnosed with GDM in an index pregnancy between January 1st 2006 and December 31st 2007 (nZ323) were invited to participate in this study, which is a substudy of GDM patients from the ongoing Atlantic DIP collaboration (8). We also recalled a control group of women who had normal glucose tolerance (NGT) during an index pregnancy during the same time period in the same location.…”

Section: Methodsmentioning

confidence: 99%

Atlantic DIP: high prevalence of abnormal glucose tolerance post partum is reduced by breast-feeding in women with prior gestational diabetes mellitus

O’Reilly

Avalos

Dennedy

et al. 2011

European Journal of Endocrinology

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Objective: Gestational diabetes (GDM) is associated with adverse fetal and maternal outcomes, and identifies women at risk of future type 2 diabetes mellitus (T2DM). Breast-feeding may improve post partum maternal glucose tolerance. Our objective was to identify the prevalence of post partum dysglycemia after GDM, to delineate associated factors and to examine the effect of lactation on post partum glucose tolerance. Design: We compared post partum 75 g oral glucose tolerance test (OGTT) results from 300 women with GDM and 220 controls with normal gestational glucose tolerance (NGT) in five regional centers. Breast-feeding data was collected at time of OGTT. Methods: Post partum OGTT results were classified as normal (fasting plasma glucose (FPG) !5.6 mmol/l, 2 h !7.8 mmol/l) and abnormal (impaired fasting glucose (IFG), FPG 5.6-6.9 mmol/l; impaired glucose tolerance (IGT), 2 h glucose 7.8-11 mmol/l; IFGCIGT; T2DM, FPG R7 mmol/lG2 h glucose R11.1 mmol/l). Binary logistic regression was used to identify factors predictive of persistent hyperglycemia. Results: Five hundred and twenty women were tested; six (2.7%) with NGT in pregnancy had post partum dysglycemia compared with 57 (19%) with GDM in index pregnancy (P!0.001). NonEuropean ethnicity (odds ratio (OR) 3.40; 95% confidence interval (CI) 1.45-8.02, PZ0.005), family history of T2DM (OR 2.14; 95% CI 1.06-4.32, PZ0.034), and gestational insulin use (OR 2.62; 95% CI 1.17-5.87, PZ0.019) were associated with persistent dysglycemia. The prevalence of persistent hyperglycemia was significantly lower in women who breast-fed vs bottle-fed post partum (8.2 vs 18.4%, P!0.001). Conclusions: Non-European ethnicity, gestational insulin use, family history of T2DM, and elevated body mass index were associated with persistent dysglycemia after GDM. Breast-feeding may confer beneficial metabolic effects after GDM and should be encouraged. European Journal of Endocrinology 165 953-959

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ATLANTIC DIP: Pregnancy Outcome for Women With Pregestational Diabetes Along the Irish Atlantic Seaboard

Cited by 66 publications

References 9 publications

Trends in Incidence of Diabetes in Pregnancy and Serious Perinatal Outcomes: A Large, Population-Based Study in Ontario, Canada, 1996–2010

Trends in Incidence of Diabetes in Pregnancy and Serious Perinatal Outcomes: A Large, Population-Based Study in Ontario, Canada, 1996–2010

Atlantic Diabetes in Pregnancy (DIP): the prevalence and outcomes of gestational diabetes mellitus using new diagnostic criteria

Atlantic DIP: high prevalence of abnormal glucose tolerance post partum is reduced by breast-feeding in women with prior gestational diabetes mellitus

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