Diabetes triples odds of stillbirth, with greater risk for women with type 2

Key takeaways:

• Women with preexisting diabetes had threefold higher odds of stillbirth and perinatal mortality.
• Risks were lower for women with type 1 vs. type 2 diabetes.

Preexisting diabetes was associated with a more than tripled odds of experiencing stillbirth or perinatal mortality, with higher risks for mothers with type 2 vs. type 1 diabetes, researchers reported in Obstetrics & Gynecology.

“Despite the well-recognized association between preexisting diabetes and stillbirth, gaps remain, including the strength of the association between preexisting diabetes and stillbirth or perinatal mortality across different populations and factors that may predict these outcomes,” Anna R. Blankstein, MD, MSc, from the department of medicine and the department of obstetrics, gynecology and reproductive sciences at the University of Manitoba in Winnipeg, Canada, and colleagues wrote.

Blankstein and colleagues conducted a systematic review and meta-analysis identifying 91 cohort studies and randomized controlled trials conducted through April 2022 (n = 17,578,678). All studies evaluated the association between preexisting diabetes and stillbirth or perinatal mortality or identified stillbirth and perinatal mortality risk factors for women with preexisting diabetes.

Preexisting diabetes was associated with higher odds of stillbirth (pooled OR = 3.74; 95% CI, 3.17-4.41) and perinatal mortality (pooled OR = 3.22; 95% CI, 2.54-4.07). In subgroup analyses, women with type 1 diabetes had lower stillbirth (pooled OR = 0.81; 95% CI, 0.68-0.95) and perinatal mortality (pooled OR = 0.73; 95% CI, 0.61-0.87) odds compared with women with type 2 diabetes.

Researchers observed significant associations between lower stillbirth (OR = 0.26; 95% CI, 0.11-0.62) and perinatal mortality (OR = 0.41; 95% CI, 0.29-0.59) odds and prenatal or prepregnancy diabetes care. In addition, women who used tobacco prenatally had higher odds of stillbirth compared with nonusers (OR = 2.18; 95% CI, 1.43-3.32).

“The finding that individuals with type 2 diabetes have higher odds of stillbirth and perinatal mortality than those with type 1 diabetes highlights the risk associated with developing type 2 diabetes, which may have a more aggressive phenotype when diagnosed at a young age,” the researchers wrote. “Future investigations should focus on identifying which individuals with type 1 and 2 diabetes are at the highest risk of stillbirth and perinatal mortality, as well as identifying the best approaches to address modifiable risk factors in these populations.”