Spontaneous preterm delivery in the type 1 diabetic pregnancy: the role of glycemic control

Kovilam, Oormila; Miodovnik, Menachem; Chames, Mark C.; Spinnato, Joseph A.; Sibai, Bahaeddine M

doi:10.1080/jmf.11.4.245.248

Cited by 29 publications

(18 citation statements)

References 7 publications

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“…We found a significant association between HbA 1c Ն7% at delivery and spontaneous preterm delivery. This is in keeping with the association reported between poor glycemic control from midpregnancy onward and spontaneous preterm delivery (5,11). In our study, polyhydramnios and macrosomia were not associated with spontaneous preterm delivery.…”

Section: Conclusion -A M O N Gsupporting

confidence: 93%

“…The rate of both spontaneous and indicated preterm delivery is increased in women with type 1 diabetes. Spontaneous preterm delivery, due to preterm labor or premature rupture of the membranes, has been associated with poor glycemic control (5,11) and urogenital infections (5). Indicated preterm delivery has been primarily related to the increased occurrence of preeclampsia in women with type 1 diabetes (6,9).…”

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confidence: 99%

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Factors Associated With Preterm Delivery in Women With Type 1 Diabetes

Lepercq¹,

Coste²,

Theau³

et al. 2004

Diabetes Care

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OBJECTIVE -The reported rate of preterm delivery in women with type 1 diabetes ranges from 22 to 45%, but the reasons are unclear. The purpose of this study was to identify factors associated with preterm delivery in these women. RESEARCH DESIGN AND METHODS-We studied the influence of maternal and diabetes-related factors on the occurrence of preterm delivery in 168 single pregnancies occurring in 127 women with type 1 diabetes. Women with spontaneous or indicated preterm delivery were compared with those who delivered after 37 weeks of gestation using polytomous logistic regression. Ն7% (7.5 [1.5-37.9]) at delivery were all associated with indicated preterm delivery. Preterm delivery was associated with significant neonatal morbidity as the risks for neonatal hypoglycemia and respiratory distress syndrome were increased by three-to sixfold compared with the reference group. RESULTSCONCLUSIONS -The rate of preterm delivery remains high in women with type 1 diabetes. Different factors were associated with spontaneous and indicated preterm delivery, respectively. Because poor glycemic control was a risk factor for both outcomes, part of preterm delivery might be preventable. Diabetes Care 27:2824 -2828, 2004R ecent surveys have shown that perinatal complications are still increased in women with type 1 diabetes (1-4). Particularly, the rate of preterm delivery ranged from 22 to 45% in women with type 1 diabetes, i.e., increased by four-to eightfold over the frequency of preterm delivery in nondiabetic single pregnancies (5-10). Preterm delivery is either spontaneous or indicated for maternal or fetal reasons. The rate of both spontaneous and indicated preterm delivery is increased in women with type 1 diabetes. Spontaneous preterm delivery, due to preterm labor or premature rupture of the membranes, has been associated with poor glycemic control (5,11) and urogenital infections (5). Indicated preterm delivery has been primarily related to the increased occurrence of preeclampsia in women with type 1 diabetes (6,9).However, in many previous studies, data on diabetes complications, preconception care, and glycemic control during pregnancy have not been systematically collected. The aim of the present study was to assess the factors that may be associated with spontaneous and indicated preterm delivery in a cohort of women with type 1 diabetes, all followed at the same institution according to a standardized protocol. A secondary objective was to determine whether risk factors for preterm delivery could be identified before or during early pregnancy and might lead to prevention. RESEARCH DESIGN ANDMETHODS -All women with type 1 diabetes and a single pregnancy who consecutively delivered after 22 weeks of gestation in the Department of Obstetrics and Gynecology, Cochin-Saint Vincent de Paul Hospital, between 1997 and were included in the study.Women of child-bearing age were informed about the need for preconception care. Preconception care included assessment of diabetes complications, review of dietary habits, int...

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Section: Conclusion -A M O N Gsupporting

confidence: 93%

mentioning

confidence: 99%

Factors Associated With Preterm Delivery in Women With Type 1 Diabetes

Lepercq¹,

Coste²,

Theau³

et al. 2004

Diabetes Care

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“…In women with type 1 diabetes who do not have diabetic nephropathy, it is well documented that the best predictor of poor pregnancy outcome is high HbA 1c early in pregnancy as well as an inappropriate reduction in HbA 1c during pregnancy (15)(16)(17)(18). In concordance with this, the HbA 1c levels were significantly elevated in pregnancies in women with type 2 diabetes during the entire pregnancy compared with the normal range.…”

Section: Outcome Of Pregnancies In Women With Type 2 Diabetes During mentioning

confidence: 73%

Poor Pregnancy Outcome in Women With Type 2 Diabetes

et al. 2005

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OBJECTIVE -To evaluate the perinatal outcome and the frequency of maternal complications in pregnancies of women with type 2 diabetes during 1996 -2001.RESEARCH DESIGN AND METHODS -Medical records of 61 consecutive singleton pregnancies in women with type 2 diabetes from 1996 to 2001 were studied. Pregnancy outcome was compared with that of pregnant women with type 1 diabetes during 1996 -2000, the background population, and pregnant women with type 2 diabetes during 1980 -1992 from the same department.RESULTS -The perinatal mortality in pregnancies complicated by type 2 diabetes (4/61, 6.6%) was increased four-and ninefold, respectively, and the rate of major congenital malformations (4/60, 6.7%) was more than doubled, although not statistically significant, compared with type 1 diabetic pregnancies and the background population. The glycemic control was similar or better in women with type 2 diabetes compared with women with type 1 diabetes. Multivariate logistic regression analysis in the pooled group of pregnancies with pregestational diabetes from 1996 to 2001 showed that high HbA 1c at admission and type 2 diabetes were independently associated with a serious adverse fetal outcome (perinatal mortality and/or major congenital malformations). The perinatal mortality and the rate of major congenital malformations in type 2 diabetic pregnancies have increased during the last decade.CONCLUSIONS -The perinatal outcome of pregnancies in women with type 2 diabetes during 1996 -2001 is poor. It is worse than the outcome of pregnancies in women with type 1 diabetes and the background population in the same period, as well as in women with type 2 diabetes studied during 1982-1990. Diabetes Care 28:323-328, 2005T he prevalence of type 2 diabetes is increasing rapidly in all age-groups. In line with this, it is a general clinical observation that the number of pregnant women with pregestational type 2 diabetes has become more frequent in the recent years; however, little knowledge exists concerning the prevalence and outcome of these pregnancies (1,2).A study from Birmingham, U.K., showed a similar perinatal mortality but a higher frequency of congenital malformations, preterm delivery, large-forgestational-age infants, and fetal loss before 24 weeks' gestation in 57 pregnancies in women with type 2 diabetes compared with pregnancies in women with type 1 diabetes (3,4). In 182 pregnancies in women with type 2 diabetes compared with the general population, there was a 2.5-fold greater risk of perinatal mortality and an 11-fold greater risk of a congenital malformation (5). A study from New Zealand reported a threefold increased perinatal mortality rate in pregnancies related to type 2 diabetes compared with pregnancies related to type 1 diabetes. In addition, the study indicated that the outcome was poorer if type 2 diabetes was diagnosed during pregnancy compared with before pregnancy (6). The prevalence of type 2 diabetes in pregnancy was the highest in non-Caucasian women, who had a nonsignificantly higher HbA 1c dur...

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“…Such clinical observations are supported by overwhelming experimental evidence from animal models that glucose is directly toxic to the developing foetus [4]. Later in pregnancy, as we have also learned, glucose should be kept as close to the norm as possible to avoid macrosomia and further neonatal morbidity [5]. Macrosomia is especially important, not only because of the obstetric problems it gives rise to, such as dystocia and need for Caesarian section, but also because it predisposes to problems in later life, such as an increased risk of the metabolic syndrome [6,7].…”

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confidence: 89%