Women With T1D, T2D Receiving Increased Intervention in Pregnancy

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Mothers with type 1 diabetes were on average 0.4 years older and more likely to be nulliparous than the general population.
Mothers with type 1 diabetes were on average 0.4 years older and more likely to be nulliparous than the general population.

Women diagnosed with diabetes may be at a higher risk for requiring an intervention during delivery with a higher overall rate of caesarian sections and earlier deliveries compared with women without diabetes, according to a study published in Diabetologia.

Using the Scottish Morbidity Record, researchers identified 813,921 women who delivered a child during the 15-year time span observed in this study and analyzed data to compare perinatal outcomes in women with pregestational diabetes (n=4681), diabetes types 1 (n= 3229) and 2 (n=1452), and those without diabetes.

Study results found 104 perinatal deaths in total, with 65 deaths in children born to mothers with type 1 diabetes and 39 in women with type 2 diabetes, resulting in rates found to be 3.1 and 4.2 times higher than in women without diabetes (P <.001).

In women with type 1 and type 2 diabetes, researchers found the stillbirth rate to be 4.0- and 5.1-fold higher (P < .001) at average gestational ages of 33.6 and 34.1 weeks, respectively, compared with rates in women without diabetes.

Women diagnosed with diabetes types 1 and 2 were found to have a higher rate of delivery by cesarean section (67.7% and 59.6%, respectively), to deliver earlier (2.6 and 2 weeks, respectively), and to deliver preterm at a rate identified as 5-fold higher in women with type 1 diabetes. Further, infants born to mothers with types 1 diabetes and type 2 diabetes were large for gestational age at a rate of 51% and 38%, respectively.

Longitudinally, women with types 1 and type 2 diabetes were older (0.6 and 1.6 years, respectively), and had increased duration of diabetes (12.4 to 14.6 and 2.6 to 3.8 years, respectively; P <.001), and rate of preterm deliveries (34.1% to 42.4% and 11.9% to 25.5%, respectively; P < .005).

The average birth weight for infants born to women with type 1 diabetes increased from 1.22 to 1.47 (P <.001), with the proportion of large for gestational age infants increasing from 47.1% to 56.2%, while rates for women with type 2 diabetes remained stable.

Researchers concluded that outcome measures such as birth weight, prematurity, cesarean delivery, and perinatal mortality may be important data for managing pregnancies that could become potentially complicated by diabetes. Based on these data, clinicians should strive to improve glycemic control in an effort to reduce risk for perinatal complications in women diagnosed with diabetes, as they have been identified as high-risk pregnancies.

Reference

Mackin ST, Nelson SM, Kerssens JJ, Wood R, et al; SDRN Epidemiology Group. Diabetes and pregnancy: national trends over a 15 year period [published online January 11, 2018]. Diabetologia. doi: 10.1007/s00125-017-4529-3

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