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Despite increased intervention, pregnancy complications persist in women with diabetes
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Pregnant women with type 1 or type 2 diabetes are more likely to experience complications at delivery vs. women without diabetes, including markedly higher rates of stillbirth and perinatal death, preterm birth and infants born large for gestational age, according to an analysis of nationally collected data from Scotland.
“In our population, outcomes for women with type 1 and type 2 diabetes remain worse than women in the background population, despite best efforts of women and their caregivers,” Robert Lindsay, MBChB, PhD, FRCP, reader in diabetes and endocrinology and honorary consultant at the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, told Endocrine Today. “There is a major unmet need for women with diabetes to develop new technologies to improve outcomes.”
Lindsay and colleagues analyzed linked data from the Scottish Morbidity Record (n = 813,921) and the Scottish Care Information-Diabetes database, including information on pregnant women with type 1 (n = 3,229) and type 2 diabetes (n = 1,452) discharged from maternity hospitals in Scotland. Data on birth weight, stillbirth and perinatal mortality from April 1998 to March 2013 were analyzed. Researchers used logistic regression analyses to compare pregnancy outcomes in women with and without diabetes.
During 15 years, researchers observed 65 perinatal deaths in the offspring of mothers with type 1 diabetes and 39 perinatal deaths in the offspring of mothers with type 2 diabetes, corresponding with rates of 3.1 and 4.2 times those in the nondiabetic population (P < .001). Compared with the stillbirth rate for mothers without diabetes, the rate was fourfold and 5.1-fold greater for mothers with type 1 and type 2 diabetes, respectively (P < .001), and occurred at a mean gestational age of 33.6 weeks and 34.1 weeks, respectively, according to researchers.
Researchers also observed an increase in births to mothers with diabetes during the 15-year period, increasing from 205 deliveries in 1998 to 264 deliveries in 2013 for mothers with type 1 diabetes (44% increase), and from 59 deliveries in 1998 to 110 deliveries in 2013 for mothers with type 2 diabetes (90% increase).
Women with type 1 and type 2 diabetes also delivered, on average, 2.6 and 2 weeks earlier, respectively, than women without diabetes, according to researchers; women with type 2 diabetes had a fivefold increased risk for preterm delivery. However, despite earlier deliveries, the mean absolute birth weights in infants born to mothers with type 1 and type 2 diabetes were on average 68.7 g and 76 g higher, respectively vs. infants born to women without diabetes, although the difference was significant only in type 2 diabetes (P < .001).
Approximately 51% of infants born to mothers with type 1 diabetes and 38% of infants born to mothers with type 2 diabetes were considered large for gestational age, the researchers wrote.
“Our findings are important because they come from a comprehensive national dataset, so [it] is complete for a geographical patient group,” Lindsay said.
Other surveys from a particular clinic or insurance system necessarily include a degree of potential patient selection. Also, the picture for complications is relatively similar for women with type 2 diabetes,” he said. “Finally, it is a strength of our study that we have longitudinal data, so we have a sense of whether outcomes are improving using current technologies.”
Lindsay said more research is needed regarding the use of continuous glucose monitoring, novel pump technologies and closed-loop systems with pregnant women to focus on improving outcomes. – by Regina Schaffer
For more information:
Robert Lindsay, MD, PhD, can be reached at the Institute of Cardiovascular and Medical Sciences University of Glasgow, 126 University Place, Glasgow G12 8TA, UK; email: robert.lindsay@glasgow.ac.uk.
Disclosures: Lindsay reports he has served on an advisory board and received speaker fees from Eli Lilly Ltd and Novo Nordisk.
Perspective
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The results of this study further illustrate the significant risks associated with pregnancies complicated by preexisting diabetes. Despite the best efforts of clinicians, women with preexisting diabetes continue to have increased risk of several adverse outcomes, from preterm delivery to a four- to five-fold increase in risk for stillbirth. Interestingly, this paper shows birth weights are increasing despite women with diabetes delivering on average 2.6 weeks earlier than women without diabetes. This finding may be explained by the contribution of other factors, such as the increasing prevalence of obesity or excessive gestational weight gain.M
Management of pregestational diabetes remains quite challenging for both patients and their health care providers. Continued advancements in diabetes technologies will assist clinicians in providing optimal care to this high-risk group of patients. It is encouraging that other studies, such as the CONCEPTT trial, show improvements in perinatal outcomes with the use of emerging technologies, such as continuous glucose monitoring (Feig DS, et al. Lancet. 2017;doi:10.1016/S0140-6736(17)32400-5). This provides us hope going forward in the quest to improve neonatal outcomes in these patients.
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