Pregnancy outcomes for women with pre‐pregnancy diabetes mellitus in Australian populations, rural and metropolitan: A review

Abstract

Background Historically, pre‐pregnancy diabetes (PPDM) is a recognised risk factor for poor pregnancy outcome. Co‐existing pathology and adverse social determinants including rural‐metropolitan inequities in health and healthcare access may confer additional risks. Multidisciplinary care before, during and after pregnancy can improve outcomes for women with PPDM and their infants. The extent to which rural Australian women and their families share in improved outcomes is unknown. We aimed to summarise maternal characteristics and pregnancy outcomes for women with PPDM, including women in rural settings and examine applications of existing clinical guidelines to rural Australian practice. Methods We sought English language population and cohort studies about PPDM using Medline, Embase, PubMed, Australian epidemiological and international clinical practice guidelines. Results Women with PPDM are changing: older, more obese, of lower parity, less likely to smoke, more likely to have type 2 rather than type 1 diabetes and shorter duration of PPDM. Women with PPDM continue to experience excess adverse pregnancy outcomes, including maternal morbidity, complicated birth, perinatal loss, congenital anomalies and mother‐infant separation. On face value, clinical guidelines appear relevant to women living in rural settings but there are only a few, conflicting outcome studies for rural women with PPDM. Conclusions PPDM is changing. A significant minority live in rural locations, and although perinatal mortality/morbidity seems to be improving, it is unclear if this is also true for rural women due to a lack of recent Australian studies. Further research is necessary to achieve excellence everywhere for women with PPDM and their babies.

Prevalence of diabetic retinopathy in women with pregestational diabetes during pregnancy and the postpartum

“…In addition to the wide range of reported DR prevalence rates and the lack of contemporary data, most available publications have only studied women with type 1 DM (T1DM), with very few studies reporting the DR prevalence in pregnant women with T2DM. As T2DM is becoming more common in pregnant women in Australia, 11 the current evidence on DR prevalence is not reflective of, and may have limited applicability to, Australia's present‐day population. More contemporary evidence is needed to update national DR guidelines for this unique and growing population.…”

Pregnancy outcomes in women with diabetes mellitus – the impact of diabetes type and treatment

“…Studies reported jaundice in about 5–20% of infants of women with GDM. A higher rate (37.0%) is found only in the preterm birth of infants of women with type 1 DM [ 37 ].…”

Markers for undiagnosed type 2 diabetes mellitus during pregnancy—A population‐based retrospective cohort study

“…Pregnancies complicated with pregestational diabetes are associated with more complications than pregnancies with gestational diabetes mellitus (GDM). These include increased risk for fetal malformations, spontaneous miscarriages, development and worsening of maternal diabetic retinopathy and nephropathy, diabetic ketoacidosis, risk of venous thromboembolism, antepartum hemorrhage, placental disorders, shoulder dystocia, neonatal hyperbilirubinemia and hypoglycemia, and increased medical cost …”

“…These include increased risk for fetal malformations, spontaneous miscarriages, development and worsening of maternal diabetic retinopathy and nephropathy, diabetic ketoacidosis, risk of venous thromboembolism, antepartum hemorrhage, placental disorders, shoulder dystocia, neonatal hyperbilirubinemia and hypoglycemia, and increased medical cost. [4][5][6][7][8][9][10][11] Pregestational diabetes should be distinguished from GDM since the pregnancy follow-up of those women is different with respect to pregnancy outcomes, management, type of glycemic control treatment, and timing of delivery. In pregestational diabetes, the mother should be evaluated for retinopathy, nephropathy, chronic hypertension, thyroid dysfunction, and infections.…”