Factors Associated With Preterm Delivery in Women With Type 1 Diabetes

Lepercq, J.; Coste, Joël; Theau, A.; Dubois‐Laforgue, Danièle; Timsit, José

doi:10.2337/diacare.27.12.2824

Cited by 82 publications

(59 citation statements)

References 22 publications

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“…Our data show a highly statistically significant association between prepregnancy care and very premature delivery and suggest that not having received prepregnancy care was an important predictor of very premature delivery, even after correction for potential confounding factors including smoking status. A recent French study of premature delivery in women with type 1 diabetes suggested that the risk of premature delivery was related to glycemic control around the time of delivery (25). In contrast, our results suggest that early glycemic control is also important as the benefits of prepregnancy care on glycemic control were greatest in early pregnancy.…”

Section: Statistical Analysescontrasting

confidence: 76%

Prepregnancy Care and Pregnancy Outcomes in Women With Type 1 Diabetes

2006

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OBJECTIVE -The objective of this study was to examine the relationship between prepregnancy care, glycemic control, maternal hypoglycemia, and pregnancy outcomes in women with type 1 diabetes.RESEARCH DESIGN AND METHODS -This was a prospective observational cohort study of women with type 1 diabetes who delivered from 1991 to 2002. Outcome measures were attendance at a clinic for prepregnancy care, maternal HbA 1c (A1C) throughout pregnancy, maternal severe hypoglycemic episodes, macrosomia, preeclampsia, premature delivery (delivery before 37 weeks), very premature delivery (delivery before 34 weeks), spontaneous abortion, and adverse pregnancy outcome (defined as major malformation, stillbirth, and neonatal death).RESULTS -There were 290 pregnancies, in which 110 (38%) women had prepregnancy care. The prepregnancy care group contained more primiparous women (54.7 vs. 40.6%; P ϭ 0.021) and fewer smokers (9.4 vs. 28.7%; P Ͻ 0.0001). They registered earlier (6.6 vs. 8.3 weeks, P Ͻ 0.0001) and had a lower A1C at the initial visit (6.5% vs. 7.6%; P Ͻ 0.0001). Adverse pregnancy outcomes and very premature deliveries were significantly lower in women who received prepregnancy care (2.9 vs. 10.2%; P ϭ 0.03 and 5.0 vs. 14.2%; P ϭ 0.02, respectively). In contrast, between groups, there was no difference in A1C after 24 weeks or in the rates of macrosomia, preeclampsia, or maternal severe hypoglycemic episodes.CONCLUSIONS -Prepregnancy care was associated with improved glycemic control in early pregnancy and significant reductions in adverse pregnancy outcome (malformation, stillbirth, and neonatal death) and very premature delivery. However, prepregnancy care failed to have an impact on glycemic control in later pregnancy or to reduce the risk of macrosomia and preeclampsia. Diabetes Care 29:1744 -1749, 2006D iabetes is the most common medical condition to complicate pregnancy, affecting 1 pregnant woman in 250 in the U.K. (1). Women with type 1 diabetes have a poor outcome compared with women without diabetes, with increased rates of congenital malformations, preeclampsia, premature delivery, perinatal mortality, and risk of delivering a macrosomic baby (2). The Confidential Enquiry into Maternal and Child Health (CEMACH) confirms a nearly fourfold rise in perinatal mortality rates and twofold rise in congenital malformation rate in women with diabetes over baseline rates in England, Wales, and Northern Ireland (1). Studies suggest that the risk of adverse outcome (malformation and perinatal mortality) is related to poor glycemic control in early pregnancy (3,4). The critical time period for optimal glycemic control is before 7 weeks' gestation, during early organogenesis (5). Prepregnancy care is the only intervention that targets glycemic control at this critical early stage and has been associated with improvements in maternal and perinatal outcomes (4,6 -13). The association of prepregnancy care with reduced risk of major congenital malformation has been further confirmed on meta-analysis (14). Some studies of macr...

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Section: Statistical Analysescontrasting

confidence: 76%

Prepregnancy Care and Pregnancy Outcomes in Women With Type 1 Diabetes

2006

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“…On the other hand, even though almost 80% of patients in 2000-2011 had their HbA 1c controlled within 12 months before pregnancy, early pregnancy glycaemic control did not improve. Poor glycaemic control increases the risk of congenital malformations [30,31], preterm delivery [32] and pre-eclampsia [33], all of which were common in our study. The rate of fetal malformations was close to the levels reported 30 years ago [5,8].…”

Section: Discussionmentioning

confidence: 56%

Obstetric and perinatal outcome in type 1 diabetes patients with diabetic nephropathy during 1988–2011

et al. 2015

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Aims/hypothesis Our aim was to analyse possible changes in the glycaemic control, BP, markers of renal function, and obstetric and perinatal outcomes of parturients with diabetic nephropathy during 1988-2011. Methods The most recent childbirth of 108 consecutive type 1 diabetes patients with diabetic nephropathy and a singleton pregnancy were studied. Two periods, 1988Two periods, -1999Two periods, and 2000Two periods, -2011 . Antihypertensive medication usage increased before pregnancy (34% vs 65%, p=0.002) and in the second and third trimesters of pregnancy (25% vs 47%, p=0.02, and 36% vs 60%, p =0.01, respectively). BP exceeded 130/ 80 mmHg in 62% and 61% (p=0.87) of patients in the first trimester, and in 95% and 93% (p=0.69) in the third trimester, respectively. No changes were observed in the markers of renal function. Pre-eclampsia (52% vs 42%, p=0.29) and preterm birth rates before 32 and 37 gestational weeks (14% vs 21%, p=0.33, and 71% vs 77%, p=0.49, respectively) remained high. The elective and emergency Caesarean section rates were 71% and 45% (p=0.01) and 29% and 48% (p= 0.05), respectively. Neonatal intensive care unit admissions increased from 26% to 49% (p=0.02). Conclusions/interpretation Early pregnancy glycaemic control and hypertension management were suboptimal in both time periods. Pre-eclampsia and preterm delivery rates remained high in patients with diabetic nephropathy.

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“…21,22 Both poor glycemic control and hypertension have previously been associated with preterm delivery among women with type 1 diabetes. [23][24][25][26] Nearly 60% of the women with IBP had hypertension, a majority of whom had chronic hypertension. The increased malformations in this group in the subset of infants with follow-up data may be reflective of poor glycemic control.…”

Section: Figurementioning

confidence: 99%

Outcomes of Extremely Preterm Infants Born to Insulin-Dependent Diabetic Mothers

et al. 2016

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BACKGROUND AND OBJECTIVE:Little is known about in-hospital morbidities and neurodevelopmental outcomes among extremely preterm infants born to women with insulin-dependent diabetes mellitus (IDDM). We examined risks of mortality, in-hospital morbidities, and neurodevelopmental outcomes at 18 to 22 months' corrected age between extremely preterm infants of women with insulin use before pregnancy (IBP), with insulin use started during pregnancy (IDP), and without IDDM.

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Factors Associated With Preterm Delivery in Women With Type 1 Diabetes

Cited by 82 publications

References 22 publications

Prepregnancy Care and Pregnancy Outcomes in Women With Type 1 Diabetes

Prepregnancy Care and Pregnancy Outcomes in Women With Type 1 Diabetes

Obstetric and perinatal outcome in type 1 diabetes patients with diabetic nephropathy during 1988–2011

Outcomes of Extremely Preterm Infants Born to Insulin-Dependent Diabetic Mothers

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