Pregnancy losses in women with Type 1 or Type 2 diabetes in the UK: an investigation using primary care records

Diabet Med. 2014 Mar;31(3):357-65. doi: 10.1111/dme.12332. Epub 2013 Nov 8.

Abstract

Aim: This study aims to investigate pregnancy losses in women with Type 1 or Type 2 diabetes and compare this with the general population.

Methods: Pregnancies ending between 1993 and 2006 in those with Type 1 or Type 2 diabetes were identified on the General Practice Research Database. Pregnancy losses were identified from medical records and the cohort described by their characteristics and prescribing for diabetes.

Results: Of 2001 pregnancies identified in women with Type 1 diabetes, 678 ended in a pregnancy loss: 19.6% were spontaneous, 9.6% were induced and 4.3% were losses for unknown reasons. In women with Type 2 diabetes, there were 240 losses in 669 pregnancies: 21.1% were spontaneous, 10.3% induced and 4.0% were losses for unknown reasons. The proportion of spontaneous losses in women with diabetes was higher than in the general population (13.2%). Women with Type 1 diabetes treated with human and analogue insulins were 60% more likely to have a delivery than a loss (odds ratio 1.6, 95% CI 1.18-2.18) compared with human insulin treatment alone, although numbers were small.

Conclusion: We found that the proportions of spontaneous losses in women with Type 1 or Type 2 diabetes were similar at approximately 20%, which is higher than in the general population and also higher than previous studies have reported. While much emphasis has been placed on pre-conception care for women with Type 1 diabetes, the same is now needed for those with Type 2 diabetes, given the similarity in outcomes and increasing prevalence of this condition.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abortion, Induced / statistics & numerical data
  • Abortion, Spontaneous / epidemiology*
  • Adolescent
  • Adult
  • Blood Glucose / metabolism*
  • Congenital Abnormalities / epidemiology
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / complications*
  • Diabetes Mellitus, Type 1 / epidemiology
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetes Mellitus, Type 2 / epidemiology
  • Directive Counseling
  • Female
  • Fetal Death
  • Glycated Hemoglobin A / metabolism*
  • Humans
  • Infant, Newborn
  • Patient Education as Topic
  • Pregnancy
  • Pregnancy Complications / blood
  • Pregnancy Complications / epidemiology*
  • Pregnancy Outcome
  • Pregnancy in Diabetics*
  • Primary Health Care
  • Risk Factors
  • Stillbirth
  • United Kingdom / epidemiology

Substances

  • Blood Glucose
  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human