Outcome of fetuses in women with pregestational diabetes mellitus

J Perinat Med. 2006;34(4):323-31. doi: 10.1515/JPM.2006.062.

Abstract

Objective: To investigate the effects of pregestational diabetes on pregnancy outcome.

Methods: Data of 126 women with pregestational diabetes prospectively collected and controlled in a single tertiary center. HbA(1C) levels at early pregnancy were registered. Adverse pregnancy outcome was defined as spontaneous abortion, congenital defect, stillbirth, or neonatal death.

Results: There were 10 spontaneous abortions (7.9%) and 17 fetuses with congenital anomalies (13.4%), including 8 major malformations (6.3%). Compared with pregnancies with a favorable outcome, a higher HbA(1C) concentration in early pregnancy was observed in pregnancies with adverse perinatal outcome [mean (SD): 6.3 (1.6) vs. 7.2 (1.7), P=0.001]. A positive correlation between increased maternal HbA(1C) levels and the rate of fetal malformations was observed, and the group of women with poor metabolic control (early maternal HbA(1c) concentration >7%) showed a 3 to 5-fold increase in the major malformation rate. Cardiovascular and genitourinary defects accounted for 58.8% of the anomalies, and the ultrasound examinations detected seven of them (41.2%). For major malformations, the detection rate was 50% (4/8). Perinatal mortality rate was 26 per thousand (3/116). There was almost 5-fold increase in the total pregnancy loss rate in the poor control group compared with the group with fair control [22.2% vs. 5.3%, OR (95% CI): 5.1 (1.4-17.1)]. Only 11.9% of mothers used a preconception care program.

Conclusions: Pregestational diabetes mellitus is a significant risk factor for the developing fetus. Spontaneous abortions and congenital defects are more common when a poor metabolic control is present in early pregnancy. It is most important to improve access to preconception care programs for achieving a good metabolic control in early pregnancy. Ultrasound examinations have a low performance for detecting congenital defects in diabetic pregnancies.

MeSH terms

  • Abortion, Spontaneous / epidemiology
  • Abortion, Spontaneous / etiology
  • Adult
  • Congenital Abnormalities / epidemiology
  • Congenital Abnormalities / etiology
  • Female
  • Fetal Death / epidemiology
  • Fetal Death / etiology
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Infant, Newborn
  • Preconception Care / statistics & numerical data
  • Pregnancy
  • Pregnancy Outcome
  • Pregnancy in Diabetics* / blood
  • Prospective Studies
  • Spain / epidemiology
  • Stillbirth / epidemiology

Substances

  • Glycated Hemoglobin A