Impact of type 1 diabetes on maternal long-term risk of hospitalisation and mortality: a nationwide combined clinical and register-based cohort study (The EPICOM study)

Knorr, Sine; Juul, Svend; Bytoft, Birgitte; Lohse, Zuzana; Clausen, Tine D.; Jensen, Rikke Beck; Damm, Peter; Beck‐Nielsen, Henning; Mathiesen, Elisabeth R.; Jensen, Dorte Moeller; Gravholt, Claus Højbjerg

doi:10.1007/s00125-018-4575-5

Cited by 8 publications

(5 citation statements)

References 30 publications

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“…The mortality rate in pregnant women with T1DM is twofold to threefold higher than for nonpregnant women with T1DM, and 5 to 20 times higher than the general obstetric population. 22,23 The precise causes of mortality may be difficult to determine because mortality may be due to pregnancy complications, the presence of T1DM, or causes unrelated to either pregnancy or T1DM. 22 It has been reported that HbA 1c levels, albuminuria around the time of conception, and the presence of underlying conditions-such as hypertension and preeclampsia-are important determinants of maternal morbidity and mortality.…”

Section: Impacts Of Maternal Dysglycemia On Maternal Outcomesmentioning

confidence: 99%

“…22 It has been reported that HbA 1c levels, albuminuria around the time of conception, and the presence of underlying conditions-such as hypertension and preeclampsia-are important determinants of maternal morbidity and mortality. 23 If the hypertensive pregnancy is associated with renal dysfunction (serum creatinine >176 lmol/L or proteinuria in the nephrotic range [>3 g/24 hour]) and/or preexisting cardiovascular disease (CVD), the risk for poor maternal outcomes increases further. 24 The prevalence rates of hypertensive disorders of pregnancy-including chronic or gestational hypertension, preeclampsia/eclampsia, and chronic hypertension with superimposed preeclampsia-are particularly high among women with diabetes.…”

Section: Impacts Of Maternal Dysglycemia On Maternal Outcomesmentioning

confidence: 99%

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Dysglycemia in Pregnancy and Maternal/Fetal Outcomes

Silva¹,

Arnegard

Maric‐Bilkan

2021

Journal of Women's Health

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Maternal dysglycemia-including diabetes, impaired glucose tolerance, and impaired fasting glucose-affects one in six pregnancies worldwide and represents a significant health risk to the mother and the fetus. Maternal dysglycemia is an independent risk factor for perinatal mortality, major congenital anomalies, and miscarriages. Furthermore, it increases the longer-term risk of type 2 diabetes mellitus, metabolic syndrome, cardiovascular morbidity, malignancies, and ophthalmic, psychiatric, and renal diseases in the mother. The most commonly encountered form of maternal dysglycemia is gestational diabetes. Currently, international consensus does not exist for diagnostic criteria defining gestational diabetes at 24-28 weeks gestation, and potential diagnostic glucose thresholds earlier in gestation require further investigation. Likewise, recommendations regarding the timing and modality (e.g., lifestyle or pharmacological) of treatment vary greatly. Because a precise diagnosis determines the appropriate treatment and outcome of the pregnancy, it is imperative that a better definition of maternal dysglycemia and its treatment be achieved. This article will address some of the controversies related to diagnosing and managing maternal dysglycemia. In addition, the article will discuss the impact of maternal dysglycemia on complications experienced by the mother and infant, both at birth and in later life.

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Section: Impacts Of Maternal Dysglycemia On Maternal Outcomesmentioning

confidence: 99%

Section: Impacts Of Maternal Dysglycemia On Maternal Outcomesmentioning

confidence: 99%

Dysglycemia in Pregnancy and Maternal/Fetal Outcomes

Silva¹,

Arnegard

Maric‐Bilkan

2021

Journal of Women's Health

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“… 2 They have 2-3 fold increase in mortality rates. 3 Neonatal complications like macrosomia, respiratory distress syndrome, Neonatal Intensive Care Unit (NICU) admissions, intrauterine growth restriction, congenital anomalies, premature birth, neonatal hypoglycemia and metabolic disorders. have been observed in pregnancies with Type-1 mothers.…”

Section: Introductionmentioning

confidence: 99%

Exploring maternal and neonatal outcomes in women with Type-1 Diabetes: A study from Pakistan

Riaz,

Askari,

Naseem

2024

Pak J Med Sci

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Background & Objective: Pregnancy in women diagnosed with Type-1 diabetes mellitus poses a higher risk of experiencing complications related to the health of the fetus, the mother, and the newborn, along with potential obstetric issues. The objective of this study was to examine the maternal and fetal outcomes, as well as complications faced by pregnant women with type-1 diabetes, and to identify potential preventable factors. Methods: This retrospective cohort study, conducted at Baqai Institute of Diabetology and Endocrinology (BIDE), Baqai Medical University, Karachi, Pakistan (January 2022 - January 2023), focused on registered pregnancies of women with Type-1 diabetes. A predesigned questionnaire recorded demographic information, diabetes and obstetric history, clinical details, treatment specifics, maternal, perinatal, and neonatal outcomes. Results: This study included 100 women with pre-existing Type-1 diabetes (mean age: 15.11 ± 5.64 years at diabetes diagnosis). Of these, 72% reported unplanned pregnancies, with a mean HbA1C at conception 8.29%. Median gestational age at delivery was 32.15 ± 10.82 weeks. Delivery outcomes included 40% normal vaginal deliveries and 60% C-sections (9% emergency, 51% elective). Stillbirths occurred in 14 cases, while 16 women experienced one miscarriage, seven had two, and 10 had three miscarriages. Glycemic targets (fasting) were achieved in 55 women, and post-meal targets only in 29, whereas, neonatal complications included hypoglycemia in 13 and low birth weight in 12 neonates. Conclusion: The high frequency of unplanned pregnancies and cesarean sections along with poor management of pre-pregnancy care and poor glycemic control results in compromised maternal and perinatal outcomes in this high-risk group. doi: https://doi.org/10.12669/pjms.40.7.9199 How to cite this: Riaz M, Askari S, Naseem R. Exploring maternal and neonatal outcomes in women with Type-1 Diabetes: A study from Pakistan. Pak J Med Sci. 2024;40(7):---------. doi: https://doi.org/10.12669/pjms.40.7.9199 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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“…Type 1 diabetes (T1DM) is a consequence of the immune-mediated destruction of β-cells with consequent loss of the ability to produce and secrete insulin [ 1 ]. T1DM in pregnant people has numerous risks for the mother and the newborn [ 2 , 3 ]. Cognitive functions are mental processes that enable a person to play an active role in perception, learning, memory, attention, and information processing.…”

Section: Introductionmentioning

confidence: 99%

Positive Association between Preserved C-Peptide and Cognitive Function in Pregnant Women with Type-1 Diabetes

et al. 2022

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This study focused on the cognitive function of women with type 1 diabetes in pregnancy. We investigated risk factors for a low cognitive score such as age, duration of Diabetes, BMI, subclinical hypothyroidism, cardiovascular autonomic neuropathy, the impact of hypo-/hyperglycemia, and C-peptide preservation. Material and methods. Seventy-eight pregnant women with type 1 diabetes (age 31.1 ± 5.4 years, diabetes duration 14.3 ± 8.9 years) were included in the study. Cognitive function was assessed in different domains, such as reasoning, memory, attention, coordination, and perception. Results. The cognitive test values ≥400 were considered high scores, and values <400 were considered low. Relative risks for low scores for general cognitive function were associated with increased BMI > 25 kg/m2 2.208 (95% CI 1.116–4.370), HbA1c > 6.5% RR 0.774 (95% CI 0.366–1.638), subclinical hypothyroidism RR 3.111 (95% CI 1.140–8.491), and impaired cardiovascular autonomic neuropathy RR 2.250 (95% CI 1.000–5.062). Pregnant women with a lower score for general cognitive function had higher BMI and higher leptin levels. Preserved C-peptide reduces the risk for cognitive impairment (RR 0.297 (95% CI 0.097–0.912)) in pregnant women with type 1 diabetes Conclusion. BMI > 25 kg/m2, subclinical hypothyroidism, and cardiovascular autonomic neuropathy are associated with increased risk, and postprandial C-peptide preservation with reduced risk for cognitive impairment in pregnant women with type 1 diabetes.

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Impact of type 1 diabetes on maternal long-term risk of hospitalisation and mortality: a nationwide combined clinical and register-based cohort study (The EPICOM study)

Cited by 8 publications

References 30 publications

Dysglycemia in Pregnancy and Maternal/Fetal Outcomes

Dysglycemia in Pregnancy and Maternal/Fetal Outcomes

Exploring maternal and neonatal outcomes in women with Type-1 Diabetes: A study from Pakistan

Positive Association between Preserved C-Peptide and Cognitive Function in Pregnant Women with Type-1 Diabetes

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