Potentially modifiable risk factors of preterm delivery in women with type 1 and type 2 diabetes

Søholm, Julie C; Vestgaard, Marianne; Àsbjörnsdóttir, Björg; Callesen, Nicoline; Pedersen, Birgith; Storgaard, Lone; Nielsen, Birgitte Bruun; Ringholm, Lene; Damm, Peter; Mathiesen, Elisabeth R.

doi:10.1007/s00125-021-05482-8

Cited by 16 publications

(5 citation statements)

References 38 publications

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“…These influences must be assumed as we do not have any value in Type 1 DM to be able to prove their implication. Our Type 1 DM have better previous metabolic control with a lower rate of nephropathy than in the studies [ 23 ] that could determine an earlier termination. In the same series, it was also observed that the mean age of preterm births in Type 2 DM was 34 weeks compared to 35 weeks in Type 1 DM, although this was not statistically significant.…”

Section: Discussionmentioning

confidence: 68%

Prematurity and congenital malformations differ according to the type of pregestational diabetes

Ballesteros,

Guarque,

Ingles

et al. 2024

BMC Pregnancy Childbirth

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Background Diabetes mellitus (DM) is the most common metabolic disorder in pregnancy. Women with Type 2 DM seems to have no better perinatal outcomes than those with Type 1 DM. Methods Single-center prospective cohort observational study. Pregnant women with diabetes (141 with Type 1 DM and 124 with Type 2 DM) that were followed in the university hospital between 2009 and 2021 were included in this study. Clinical data and obstetric and perinatal outcomes were collected. Results As expected, women with Type 1 DM were younger and had a longer duration of diabetes than women with Type 2 DM. Obesity and chronic hypertension were higher in the group of women with Type 2 DM and their value of HbA1c in the second and third trimesters were lower than in Type 1 DM. No differences in prematurity were found, but more extreme prematurity was observed in Type 2 DM, as well as a higher rate of congenital malformations. The frequency of hypoglycemia and the weight of the newborn was higher in Type 1 DM. The maternal independent factors related to the weight of the newborn were: the glycemic control at the third trimester, the weight gain during pregnancy, and pregestational BMI. Conclusions Newborns born to mothers with Type 1 DM were larger and had a higher frequency of hypoglycemia, while congenital malformations and precocious preterm was more associated to Type 2 DM. Metabolic control, weight gain and pregestational weight were important determinants of both obstetric and neonatal complications.

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Section: Discussionmentioning

confidence: 68%

Prematurity and congenital malformations differ according to the type of pregestational diabetes

Ballesteros,

Guarque,

Ingles

et al. 2024

BMC Pregnancy Childbirth

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“…22 In the current study, around 25% of women delivered preterm. Even though rates of preterm birth in type 1 diabetes of 35%-40% have been reported from some other countries, 22,23 the rate of 25% in Sweden is still 5 times that of the general obstetric population 21 and has not changed since the mid-80s. 24 In a recent study of ours based on national data from Sweden between 1998 and 2015, rates of preterm birth in T1D and in the general obstetric population were 22.5% and 4.6% respectively.…”

Section: Discussionmentioning

confidence: 90%

Preterm delivery and maternal obesity remain common complications in pregnancies with type 1 diabetes—A nationwide study in Sweden

Sandin,

Järnbert‐Pettersson,

Persson

2024

Diabet Med

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AimA primary goal of obstetric care of women with type 1 diabetes (T1D) is to reduce the risks of preterm birth (PTB). Besides hyperglycaemia, maternal obesity is an important risk factor for PTB in T1D. However, it's unclear if public health efforts decreased risks of maternal obesity and PTB in pregnancies with T1D. We examined time‐trends over the last 20 years in the distribution of gestational ages at birth (GA) in offspring of women with T1D in Sweden, and in maternal BMI in the same mothers.MethodsPopulation‐based cohort study, using data from national registries in Sweden. To capture differences not only in the median values, we used quantile regression models to compare the whole distributions of GA's and early pregnancy BMI between deliveries in 1998–2007 (P1) and 2008–2016 (P2). Multivariable models were adjusted for differences in maternal age, smoking and education between periods 1 and 2.ResultsThe study included 7639 offspring of women with T1D between 1998 and 2016. The 10% percentile GA, increased with 0.09 days (95% CI: −0.11 to 0.35) between P1 and P2. The 90% percentile for BMI was 1.20 kg/m2 higher (95% CI: 0.57 to 1.83) in P2. Risks of PTB remained stable over time also when adjusting for maternal BMI.ConclusionDespite modern diabetes management, the distribution of GA, and consequently the risk of PTB in T1D, remained unchanged from 1998 to 2016. During the same time, maternal BMI increased, particularly in the already obese.

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“…Even in countries such as Australia where prenatal care is readily available, glycaemic control is well managed and with specialist care, type 2 diabetes remains a risk for several negative pregnancy outcomes (16). Soholm et al 2021 found pre-eclampsia and foetal asphyxia to be the main reasons for delivering preterm in diabetic pregnancies (25).…”

Section: Discussionmentioning

confidence: 99%

Evaluating the impact of maternal non-communicable disease on adverse pregnancy outcomes and birthweight in Pakistan.

Wainwright

Sheikh

Qureshi

et al. 2023

Preprint

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Background Non-communicable diseases (NCDs) account for 74% of all global deaths and disproportionately affect lower to middle-income countries (LMICs) like Pakistan. NCDs increase the risk of adverse pregnancy outcomes including preterm birth (PTB), caesarean section (CS) and low birthweight that negatively affect the mother, her offspring and future population health in an intergenerational cycle, resulting from adverse pregnancy outcomes significantly increasing development of NCDs in the adult offspring. Methods This study used multinomial logistic regression and generalised linear models to investigate the impact of common NCDs (type 1 and 2 diabetes, hypertension, asthma and thyroid disorders) on adverse pregnancy outcomes and birthweight in Pakistan. Retrospective data from 817 pregnant Pakistani women with pre-existing NCDs were adjusted for confounding factors to calculate odds ratios and means. Results Type 2 diabetes increased the risk of preterm birth (aOR 2.05, P = 0.044), elective CS (aOR 3.5, P = 0.036) and labour induction (aOR 3.29, P = 0.056). Elective CS risk was also increased significantly in mothers exhibiting hypertension (aOR 3.22, P = 0.033) or asthma (aOR 3.9, P = 0.011). Interestingly, preterm birth was significantly halved in pregnant mothers with asthma (aOR 0.4, P < 0.047). The only NCD disease to have a significant impact on birthweight was type 1 diabetes, where it was increased with a birthweight of 3253g compared to 2832g (P < 0.001). Operative deliveries were identified to be very high, with elective CS being the most common, increasingly significantly in 3 out of the 5 NCDs investigated. High operative deliveries may result from Pakistan’s privatised health care system and a lack of public awareness on the associated risks. Conclusions In conclusion, NCDs increase the risk of some adverse pregnancy outcomes. With the surprising finding that asthma halves PTB, further research to determine potential mechanisms and drug therapies to manage or prevent PTB are justified.

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Potentially modifiable risk factors of preterm delivery in women with type 1 and type 2 diabetes

Cited by 16 publications

References 38 publications

Prematurity and congenital malformations differ according to the type of pregestational diabetes

Prematurity and congenital malformations differ according to the type of pregestational diabetes

Preterm delivery and maternal obesity remain common complications in pregnancies with type 1 diabetes—A nationwide study in Sweden

Evaluating the impact of maternal non-communicable disease on adverse pregnancy outcomes and birthweight in Pakistan.

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