Pregnancy in women with Type 2 diabetes: 12 years outcome data 1990-2002

Diabet Med. 2003 Sep;20(9):734-8. doi: 10.1046/j.1464-5491.2003.01017.x.

Abstract

Aim: Twelve years' outcome analysis of pregnancies in women with Type 2 diabetes in a multiethnic geographically defined area.

Methods: Information about 182 women delivered between 1990 and 2002 was ascertained from a regional computerized database. The main outcome measures were rates of miscarriage, stillbirth, neonatal/postnatal deaths, congenital malformations, birth weight, mode of delivery, and neonatal unit care as well as maternal morbidities of polyhydramnios, postpartum haemorrhage, pregnancy-induced hypertension/pre-eclampsia.

Results: Among 182 singleton pregnancies, 161 (88%) resulted in a live outcome. There were 16 (8.8%) spontaneous miscarriages, two (1.2%) stillbirths, and three (1.6%) terminations. Congenital malformations occurred in 18 pregnancies (99/1000). There were two early and one late neonatal deaths and two further deaths in the postnatal period. Twenty-eight percent of infants were large for gestational age, with 15 (9.3%) greater than 4 kg. Fifty-three percent were delivered by caesarean section and 68 (37%) required admission to neonatal unit (NNU) care. Hypertension/pre-eclampsia was two times, polyhydramnios three times, and postpartum haemorrhage six times more common than in non-diabetic women.

Conclusions: Women with Type 2 diabetes have a less satisfactory pregnancy outcome compared with the general population. Infants have a two-fold greater risk of stillbirth, a 2.5-fold greater risk of a perinatal mortality, a 3.5-fold greater risk of death within the first month and a six-fold greater risk of death up to 1 year compared with regional/national figures. They have an 11 times greater risk of a congenital malformation. We need to develop better educational and screening strategies if we are to improve.

MeSH terms

  • Abortion, Spontaneous / epidemiology
  • Adolescent
  • Adult
  • Birth Weight
  • Congenital Abnormalities / epidemiology
  • Delivery, Obstetric / methods
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / epidemiology*
  • England / epidemiology
  • Female
  • Fetal Death / epidemiology
  • Glycated Hemoglobin A / analysis
  • Humans
  • Hypertension / epidemiology
  • Infant Mortality
  • Infant, Newborn
  • Middle Aged
  • Postpartum Hemorrhage / epidemiology
  • Pre-Eclampsia / epidemiology
  • Pregnancy
  • Pregnancy Complications, Cardiovascular / epidemiology
  • Pregnancy Outcome*
  • Pregnancy in Diabetics / blood
  • Pregnancy in Diabetics / epidemiology*
  • Retrospective Studies

Substances

  • Glycated Hemoglobin A