Association of types of diabetes and insulin dependency on birth outcomes

Pamela K Xaverius; Steven W Howard; Deborah Kiel; Jerry E Thurman; Ethan Wankum; Catherine Carter; Clairy Fang; Romi Carriere

doi:10.12998/wjcc.v10.i7.2147

Association of types of diabetes and insulin dependency on birth outcomes

World J Clin Cases. 2022 Mar 6;10(7):2147-2158. doi: 10.12998/wjcc.v10.i7.2147.

Authors

Pamela K Xaverius¹, Steven W Howard², Deborah Kiel³, Jerry E Thurman⁴, Ethan Wankum³, Catherine Carter⁵, Clairy Fang⁶, Romi Carriere⁷

Affiliations

¹ Department of Epidemiology and Biostatistics, Saint Louis University, St. Louis, MO 63104, United States. pam.xaverius@slu.edu.
² Department of Health Management and Policy, Saint Louis University, St. Louis, MO 63104, United States.
³ Department of Epidemiology and Biostatistics, Saint Louis University, St. Louis, MO 63104, United States.
⁴ Department of Endocrinology, Diabetes and Metabolism, SSM Health, St. Charles, MO 63303, United States.
⁵ Division of Epidemiology, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI 53226, United States.
⁶ Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA 90095, United States.
⁷ Population Health Sciences Institute, Centre for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, England NE4 5PL, United Kingdom.

Abstract

Background: Diabetes rates among pregnant women in the United States have been increasing and are associated with adverse pregnancy outcomes.

Aim: To investigate differences in birth outcomes (preterm birth, macrosomia, and neonatal death) by diabetes status.

Methods: Cross-sectional design, using linked Missouri birth and death certificates (singleton births only), 2010 to 2012 (n = 204057). Exposure was diabetes (non-diabetic, pre-pregnancy diabetes-insulin dependent (PD-I), pre-pregnancy diabetes-non-insulin dependent (PD-NI), gestational diabetes- insulin dependent (GD-I), and gestational diabetes-non-insulin dependent (GD-NI)]. Outcomes included preterm birth, macrosomia, and infant mortality. Confounders included demographic characteristics, adequacy of prenatal care, body mass index, smoking, hypertension, and previous preterm birth. Bivariate and multivariate logistic regression assessed differences in outcomes by diabetes status.

Results: Women with PD-I, PD-NI, and GD-I remained at a significantly increased odds for preterm birth (aOR 2.87, aOR 1.77, and aOR 1.73, respectively) and having a very large baby [macrosomia] (aOR 3.01, aOR 2.12, and aOR 1.96, respectively); in reference to non-diabetic women. Women with GD-NI were at a significantly increased risk for macrosomia (aOR1.53), decreased risk for their baby to die before their first birthday (aOR 0.41) and no difference in risk for preterm birth in reference to non-diabetic women.

Conclusion: Diabetes is associated with the poor birth outcomes. Clinical management of diabetes during pregnancy and healthy lifestyle behaviors before pregnancy can reduce the risk for diabetes and poor birth outcomes.

Keywords: Birth outcomes; Epidemiology; Gestational diabetes; Health care delivery; Insulin; Pregnancy.