Trends in prevalence and outcomes of pregnancy in women with pre‐existing type I and type II diabetes

Bell, Ruth; Bailey, Katie; Cresswell, Tim; Hawthorne, Gillian; Critchley, Julia; Lewis‐Barned, Nick

doi:10.1111/j.1471-0528.2007.01644.x

Cited by 191 publications

(162 citation statements)

References 34 publications

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“…A large population-based study from northern England recently reported improvements in glycaemic control and pregnancy outcomes among obstetric type 1 diabetic patients after amendments in the organisation and consistency of care as well as in region-wide audit and feedback practices [12]. Increased use of continuous glucose monitoring has been shown to improve second and third trimester glycaemic control in type 1 diabetic patients [37].…”

Section: Discussionmentioning

confidence: 99%

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Trends in maternal BMI, glycaemic control and perinatal outcome among type 1 diabetic pregnant women in 1989–2008

et al. 2012

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Aims/hypothesis Our objective was to examine the trends in prepregnancy BMI and glycaemic control among Finnish type 1 diabetic patients and their relation to delivery mode and perinatal outcome. Methods We analysed the obstetric records of 881 type 1 diabetic women with a singleton childbirth during 1989-2008. Maternal prepregnancy weight and height were obtained from the maternity cards, where they are recorded as reported by the mother. Results Maternal BMI increased significantly during 1989-2008 (p<0.001). The mean HbA 1c in the first trimester remained unchanged, but the midpregnancy and the last HbA 1c before delivery increased (p00.009 and 0.005, respectively). Elective Caesarean sections (CS) decreased (p for trend <0.001), while emergency CS increased (p for trend <0.001). The mean umbilical artery (UA) pH decreased in vaginal deliveries (p for trend <0.001). The frequency of UA pH <7.15 and <7.05 increased (p for trend <0.001 and 0.008, respectively). The macrosomia rate remained at 32-40%. Neonatal intensive care unit (NICU) admissions increased (p for trend 0.03) and neonatal hypoglycaemia frequency decreased (p for trend 0.001). In multiple logistic regression analysis, maternal BMI was associated with macrosomia and NICU admission. The last HbA 1c value before delivery was associated with delivery before 37 weeks' gestation, UA pH <7.15, 1 min Apgar score <7, macrosomia, NICU admission and neonatal hypoglycaemia. Conclusions/interpretation Self-reported pregestational BMI has increased and glycaemic control during the second half of pregnancy has deteriorated. Poor glycaemic control seems to be associated with the observed increases in adverse obstetric and perinatal outcomes.

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Section: Discussionmentioning

confidence: 99%

“…Numerous studies indicate that the rates of perinatal complications among type 1 diabetic patients are still substantially higher than those of the general population [4][5][6][7][8][9][10][11]. Only a few centres have shown improvement in the outcomes of type 1 diabetic pregnancies in recent decades [12,13].…”

Section: Introductionmentioning

confidence: 99%

Trends in maternal BMI, glycaemic control and perinatal outcome among type 1 diabetic pregnant women in 1989–2008

et al. 2012

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“…NorDIP collects details of all known pregnancies occurring in the region, irrespective of outcome, in women diagnosed with diabetes at least 6 months before the index pregnancy [18]. All maternity units within the region participate in the survey.…”

Section: Methodsmentioning

confidence: 99%

HbA1c and birthweight in women with pre-conception type 1 and type 2 diabetes: a population-based cohort study

et al. 2012

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Aims/hypothesis To investigate clinical and sociodemographic predictors of birthweight in singletons born to women with type 1 or type 2 diabetes. Methods Normally formed singleton live births and intrapartum stillbirths, born to women with pre-conception diabetes during 1996-2008, were identified from the population-based Northern Diabetes in Pregnancy Survey (n01,505). Associations between potential predictors and birthweight were analysed by multiple regression. Results Potentially modifiable independent predictors of increase in birthweight were pre-pregnancy care (adjusted regression coefficient [b]087.1 g; 95% CI 12.9, 161.3), increasing third-trimester HbA 1c ≤7% (53 mmol/mol) (b0310.5 g per 1% [11 mmol/mol]; 95% CI 246.3, 374.7) and increasing maternal BMI (b09.5 g per 1 kg/m 2 ; 95% CI 3.5, 15.5). Smoking during pregnancy (b0−145.1 g; 95% CI −231.4, −58.8), later gestation at first antenatal visit (b0−15.0 g; 95% CI −26.9, −3.0) and higher peri-conception HbA 1c (b0−48.2 g; 95% CI −68.8, −27.6) were independently associated with birthweight reduction. Pre-pregnancy nephropathy (b 0−282.7 g; 95% CI −461.8, −103.6) and retinopathy (b0−175.5 g; 95% CI −269.9, −81.0) were independent non-modifiable predictors of reduced birthweight, while greater maternal height was a non-modifiable predictor of increasing birthweight (b017.8 g; 95% CI 12.3, 23.2). Other predictors of birthweight increase were male sex, multiparity and increasing gestational age at delivery. Type or duration of diabetes, socioeconomic status and ethnicity were not associated with continuous birthweight. Conclusions/interpretation Poor glycaemic control before and throughout pregnancy is associated with abnormal fetal growth, with increasing peri-conception HbA 1c predicting weight reduction and increasing third-trimester HbA 1c predicting increased birthweight. Women with microvascular complications of diabetes may require increased surveillance to detect fetal growth restriction.

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“…There is little data on whether the rates of these serious outcomes have changed over time in women with diabetes. Only two studies have looked at trends in outcomes in women with diabetes over the last decade, in Germany (data up to 2004) and the U.K. (data up to 2007), and both failed to find significant decreases in perinatal mortality or congenital anomalies (13,14). Using unique population-based databases that link maternal and fetal health records, the aim of this population-based study was to compare rates of serious perinatal outcomes between women with and without diabetes in pregnancy, explore whether these rates have changed over time, and relate these rates to the underlying trends in rates of diabetes in pregnancy over the past 14 years.…”

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confidence: 99%

Trends in Incidence of Diabetes in Pregnancy and Serious Perinatal Outcomes: A Large, Population-Based Study in Ontario, Canada, 1996–2010

et al. 2014

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OBJECTIVEWomen with diabetes in pregnancy have high rates of pregnancy complications. Our aims were to explore trends in the incidence of diabetes in pregnancy and examine whether the risk of serious perinatal outcomes has changed. RESEARCH DESIGN AND METHODSWe performed a population-based cohort study of 1,109,605 women who delivered in Ontario, Canada, between 1 April 1996 and 31 March 2010. We categorized women as gestational diabetes (GDM) (n = 45,384), pregestational diabetes (pre-GDM) (n = 13,278), or no diabetes (n = 1,050,943). The annual age-adjusted rates of diabetes in pregnancy were calculated, and rates of serious perinatal outcomes were compared between groups and by year using Poisson regression. RESULTSThe age-adjusted rate of both GDM (2.7-5.6%, P < 0.001) and pre-GDM (0.7-1.5%, P < 0.001) doubled from 1996 to 2010. The rate of congenital anomalies declined by 23%, whereas the rate of perinatal mortality did not change significantly. However, compared with women with no diabetes, women with pre-GDM and GDM faced an increased risk of congenital anomalies (relative risk 1.86 [95% CI 1.49-2.33] and 1.26 [1.09-1.45], respectively), and perinatal mortality remained elevated in women with pre-GDM (2.33 [1.59-3.43]). CONCLUSIONSThe incidence of both GDM and pre-GDM in pregnancy has doubled over the last 14 years, and the overall burden of diabetes in pregnancy on society is growing. Although congenital anomaly rates have declined in women with diabetes, perinatal mortality rates remain unchanged, and the risk of both remains significantly elevated compared with nondiabetic women. Increased efforts are needed to reduce these adverse outcomes.Diabetes in pregnancy is becoming an increasingly growing concern as the prevalence of diabetes continues to rise (1). Women with diabetes who become pregnant have an increased risk of pregnancy complications (2-7), including serious perinatal outcomes such as stillbirth, perinatal mortality, and major congenital malformations. Hyperglycemia in the period around conception and the first weeks

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Trends in prevalence and outcomes of pregnancy in women with pre‐existing type I and type II diabetes

Abstract: Objective To describe recent trends in prevalence, outcomes and indicators of care for women with pre-existing type I or type II diabetes.Design Regional population-based survey.

Cited by 191 publications

References 34 publications

Trends in maternal BMI, glycaemic control and perinatal outcome among type 1 diabetic pregnant women in 1989–2008

Trends in maternal BMI, glycaemic control and perinatal outcome among type 1 diabetic pregnant women in 1989–2008

HbA1c and birthweight in women with pre-conception type 1 and type 2 diabetes: a population-based cohort study

Trends in Incidence of Diabetes in Pregnancy and Serious Perinatal Outcomes: A Large, Population-Based Study in Ontario, Canada, 1996–2010

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