medwireNews: Study results suggest that pregnant women with diabetes have a greater risk for adverse birth outcomes than those without diabetes, despite receiving a higher degree of obstetric intervention.
Robert Lindsay (University of Glasgow, UK) and colleagues carried out an analysis of all 813,921 deliveries that occurred in Scotland over a 15-year period, finding that the number of women with diabetes who entered pregnancy increased significantly over time.
Specifically, the proportion of babies born to women with type 1 diabetes rose from approximately 0.38% in 1998–1999 to 0.45% in 2012–2013, translating into a significant 44% increase in a fitted model, while there was a significant 90% increase in deliveries among women with type 2 diabetes, from approximately 0.10% to 0.20%.
The team found “marked differences” in pregnancy outcomes for women with versus without diabetes; babies born to women with type 1 or type 2 diabetes were delivered significantly earlier (36.7 and 37.3 versus 39.3 weeks), and were more likely to be born by elective (29.4 and 30.5 vs 9.6%) or emergency (38.3 and 29.1 vs 14.6%) cesarean section. Rates of cesarean section increased over time among women with diabetes, with the exception of emergency rates in those with type 1 diabetes, which remained stable.
However, in spite of the increased obstetric intervention and earlier delivery, babies born to mothers with type 1 or type 2 diabetes were heavier than those born to women without diabetes, at a mean 3466.7 g and 3474.4 g versus 3398.8 g, and were more likely to be large for gestational age, with rates of 50.9% and 38.4% versus 10.5%.
Moreover, rates of stillbirth were approximately fourfold higher for women with type 1 diabetes, and fivefold higher for those with type 2 diabetes, compared with those without diabetes (19.5 and 24.8 vs 4.9%), and remained unchanged over the study period, report the researchers in Diabetologia.
Taken together, these findings indicate that “[t]here is a major unmet need to improve perinatal outcomes for women with diabetes treated during pregnancy,” write Lindsay and team.
They emphasize that “[p]regnancy for women with diabetes remains high risk, and much is still to be understood regarding causes and effective interventions for adverse outcomes.”
And looking to the future, the researchers call for a comparison of pregnancy complication rates among mothers with diabetes across different settings in order to “understand the potential for improvement both in Scotland and on a wider international level.”
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