Pregnancy complications more frequent with undiagnosed type 2 diabetes
Click Here to Manage Email Alerts
Missing a type 2 diabetes diagnosis before pregnancy may lead to complications during pregnancy and delivery for mothers and their children, according to findings published in Diabetic Medicine.
“Undiagnosed type 2 diabetes is not that uncommon,” Denice Feig, MD, MSc, associate professor in the department of medicine at the University of Toronto, told Healio. “Recognition early with close attention to excellent glycemic control and careful obstetric monitoring is advised although efforts to diagnose prior to pregnancy would be ideal.”
Feig and colleagues assessed the frequency of preeclampsia, cesarean section, shoulder dystocia, perinatal mortality, preterm delivery, neonatal ICU visitation, respiratory distress syndrome, small for gestational age, large for gestational age, congenital anomalies, hyperbilirubinemia and neonatal hypoglycemia during the pregnancies of 1,772 women with undiagnosed type 2 diabetes (53% aged 26-34 years), 66,391 women with gestational diabetes alone (55% aged 26-34 years), 16,283 women with diagnosed preexisting diabetes (54% aged 26-34 years) and 911,544 women without diabetes of any kind (58% aged 26-34 years). Women who had gestational diabetes and then developed diabetes in the year after pregnancy were considered to have undiagnosed type 2 diabetes. The researchers identified complications and diabetes status from 2002 to 2015 via administrative health care data.
The odds for preeclampsia (OR = 1.56; 95% CI, 1.35-1.79), cesarean section (OR = 1.33; 95% CI, 1.21-1.46) and shoulder dystocia (OR = 1.36; 95% CI, 1.06-1.74) were all greater for women with undiagnosed type 2 diabetes than for those with gestational diabetes. The odds were also greater for perinatal mortality (OR = 3.37; 95% CI, 2.28-4.98), delivery before 37 weeks (OR = 1.68; 95% CI, 1.47-1.92), delivery before 34 weeks (OR = 1.7; 95% CI, 1.31-2.21), neonatal ICU visitation (OR = 1.86; 95% CI, 1.66-2.08) respiratory distress syndrome (OR = 1.82; 95% CI, 1.3-2.56), large for gestational age (OR = 1.98; 95% CI, 1.76-2.23), congenital anomalies (OR = 1.77; 95% CI, 1.44-2.17), hyperbilirubinemia (OR = 1.47; 95% CI, 1.26-1.72) and neonatal hypoglycemia (OR = 1.9; 95% CI, 1.71-2.12) when examining differences in delivery results between the groups. The odds for complications during pregnancy and delivery were similar for women with undiagnosed type 2 diabetes and those with diabetes diagnosed before pregnancy.
The researchers noted that when women were diagnosed with gestational diabetes before 20 weeks, had gestational diabetes with an earlier pregnancy, had a low income, had chronic hypertension or had given birth at least three times before, undiagnosed type 2 diabetes was easier to predict.
“It is important to realize these women with gestational diabetes have outcomes similar to women with recognized type 2 diabetes and they should be treated as such,” Feig said. “Unfortunately they miss out on early treatment, therefore recognition pre-pregnancy with proper preconception care would be ideal.” – by Phil Neuffer
For more information:
Denice Feig, MD, MSc, can be reached at d.feig@utoronto.ca.
Disclosures: The authors report no relevant financial disclosures.
Perspective
Back to Top
Grenye O'Malley, MD
This article addresses one of the biggest obstacles in studying gestational diabetes, which is the heterogeneity of cases and the difficulty we have at accurately diagnosing different types of diabetes in pregnancy. We know that undiagnosed pregestational diabetes must be common, but it is difficult to quantify. Since this study based on diagnosis data could not determine if postpartum testing was done, it is likely underestimating the number of women with undiagnosed diabetes. Women with pre-existing diabetes are also more likely to have miscarriages, and this group would not be represented in this study.
A surprising finding was that women in the undiagnosed diabetes group were more likely to have seen a primary care provider leading up to pregnancy. This can be interpreted as disappointing considering the diagnosis was missed but also hopeful that there is an intervention point that can be addressed.
This paper reiterates the increased risk of pregestational diabetes with poor pregnancy outcomes such as preeclampsia, which in turn are associated with long-term health risks such as cardiovascular disease in the mother. Figuring out how to identify these risk factors better before, during and after pregnancy could have an impact on the rest of the mother’s life.
Click Here to Manage Email Alerts