The association between gestational diabetes and stillbirth: a systematic review and meta-analysis

Lemieux, Patricia; Benham, Jamie L; Donovan, Lois; Moledina, N.; Pylypjuk, Christy; Yamamoto, Jennifer M.

doi:10.1007/s00125-021-05579-0

Cited by 13 publications

(2 citation statements)

References 107 publications

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“…Secondly, despite the established association between male infant sex and NND [ 53 , 54 ], this was not identified as a risk factor in any ethnic group. In contrast, both type 1 and type 2 diabetes were identified as risk factors for perinatal mortality, consistent with existing literature [ 55 ], but we were unable to identify a relationship between GDM and stillbirth [ 56 ].…”

Section: Discussionsupporting

confidence: 88%

An in-depth analysis of perinatal related mortality among women of South Asian ethnicity in Aotearoa New Zealand

Graaff

Sadler

Lakhdhir

et al. 2023

BMC Pregnancy Childbirth

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Background International and national New Zealand (NZ) research has identified women of South Asian ethnicity at increased risk of perinatal mortality, in particular stillbirth, with calls for increased perinatal research among this ethnic group. We aimed to analyse differences in pregnancy outcomes and associated risk factors between South Asian, Māori, Pacific and NZ European women in Aotearoa NZ, with a focus on women of South Asian ethnicity, to ultimately understand the distinctive pathways leading to adverse events. Methods Clinical data from perinatal deaths between 2008 and 2017 were provided by the NZ Perinatal and Maternal Mortality Review Committee, while national maternity and neonatal data, and singleton birth records from the same decade, were linked using the Statistics NZ Integrated Data Infrastructure for all births. Pregnancy outcomes and risk factors for stillbirth and neonatal death were compared between ethnicities with adjustment for pre-specified risk factors. Results Women of South Asian ethnicity were at increased risk of stillbirth (aOR 1.51, 95%CI 1.29–1.77), and neonatal death (aOR 1.51, 95%CI 1.17–1.92), compared with NZ European. The highest perinatal related mortality rates among South Asian women were between 20–23 weeks gestation (between 0.8 and 1.3/1,000 ongoing pregnancies; p < 0.01 compared with NZ European) and at term, although differences by ethnicity at term were not apparent until ≥ 41 weeks (p < 0.01). No major differences in commonly described risk factors for stillbirth and neonatal death were observed between ethnicities. Among perinatal deaths, South Asian women were overrepresented in a range of metabolic-related disorders, such as gestational diabetes, pre-existing thyroid disease, or maternal red blood cell disorders (all p < 0.05 compared with NZ European). Conclusions Consistent with previous reports, women of South Asian ethnicity in Aotearoa NZ were at increased risk of stillbirth and neonatal death compared with NZ European women, although only at extremely preterm (< 24 weeks) and post-term (≥ 41 weeks) gestations. While there were no major differences in established risk factors for stillbirth and neonatal death by ethnicity, metabolic-related factors were more common among South Asian women, which may contribute to adverse pregnancy outcomes in this ethnic group.

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Section: Discussionsupporting

confidence: 88%

An in-depth analysis of perinatal related mortality among women of South Asian ethnicity in Aotearoa New Zealand

Graaff

Sadler

Lakhdhir

et al. 2023

BMC Pregnancy Childbirth

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“…29 Our cohort included only females with type 2 diabetes, whereas the Quebec cohort did not differentiate by type of preexisting diabetes. 29,30 More recent data from the United Kingdom showed that although people with type 2 diabetes are more likely to reach glycemic control targets throughout pregnancy than people with type 1 diabetes, severe adverse neonatal outcomes are as common or more common. 5,31 We postulate that the higher risk of still birth and perinatal death among First Nation pregnant indi viduals is likely multifactorial and may include factors such as access to care, differences in socioeconomic status, higher rates of obesity or abovetarget glycemic control, and systemic racism within our health care system.…”

Section: Discussionmentioning

confidence: 99%

Maternal and neonatal outcomes in pregnancies with type 2 diabetes in First Nation and other Manitoban people: a population-based study

Yamamoto

Pylypjuk

Sellers

et al. 2022

cmajo

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Background: First Nation people living in Canada experience a high prevalence of type 2 diabetes in pregnancy. In this study, we aimed to describe maternal and neonatal outcomes in First Nation and all other females with type 2 diabetes living in Manitoba, Canada.Methods: This was a population-level retrospective cohort study using linked administrative data from Manitoba (2012Manitoba ( -2017. We compared First Nation females with type 2 diabetes with all other Manitoban females with type 2 diabetes, using relative risks (RRs) and 95% confidence intervals (CIs).Results: A total of 2181 females with type 2 diabetes were included, and 1218 (55.8%) were First Nation. First Nation females with type 2 diabetes were significantly more likely to experience stillbirth (RR 2.14, 95% CI 1.11-4.13) and perinatal death (RR 2.39, 95% CI 1.37-4.17) than all other Manitoban females with type 2 diabetes. Offspring of First Nation females with type 2 diabetes had a higher risk of most neonatal complications than offspring of all other Manitoban females with type 2 diabetes, including a higher risk of congenital malformations (RR 1.97, 95% CI 1.30-2.99), but First Nation people did not have a higher risk of most maternal complications.Interpretation: First Nation pregnant individuals living with type 2 diabetes experienced a higher risk for adverse pregnancy outcomes than all other Manitoban females with type 2 diabetes. Additional studies are needed to identify both high-risk and protective factors for pregnancy complications in First Nation people living with type 2 diabetes in pregnancy.

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