OBJECTIVE -To evaluate the perinatal outcome and the frequency of maternal complications in pregnancies of women with type 2 diabetes during 1996 -2001.RESEARCH DESIGN AND METHODS -Medical records of 61 consecutive singleton pregnancies in women with type 2 diabetes from 1996 to 2001 were studied. Pregnancy outcome was compared with that of pregnant women with type 1 diabetes during 1996 -2000, the background population, and pregnant women with type 2 diabetes during 1980 -1992 from the same department.RESULTS -The perinatal mortality in pregnancies complicated by type 2 diabetes (4/61, 6.6%) was increased four-and ninefold, respectively, and the rate of major congenital malformations (4/60, 6.7%) was more than doubled, although not statistically significant, compared with type 1 diabetic pregnancies and the background population. The glycemic control was similar or better in women with type 2 diabetes compared with women with type 1 diabetes. Multivariate logistic regression analysis in the pooled group of pregnancies with pregestational diabetes from 1996 to 2001 showed that high HbA 1c at admission and type 2 diabetes were independently associated with a serious adverse fetal outcome (perinatal mortality and/or major congenital malformations). The perinatal mortality and the rate of major congenital malformations in type 2 diabetic pregnancies have increased during the last decade.CONCLUSIONS -The perinatal outcome of pregnancies in women with type 2 diabetes during 1996 -2001 is poor. It is worse than the outcome of pregnancies in women with type 1 diabetes and the background population in the same period, as well as in women with type 2 diabetes studied during 1982-1990. Diabetes Care 28:323-328, 2005T he prevalence of type 2 diabetes is increasing rapidly in all age-groups. In line with this, it is a general clinical observation that the number of pregnant women with pregestational type 2 diabetes has become more frequent in the recent years; however, little knowledge exists concerning the prevalence and outcome of these pregnancies (1,2).A study from Birmingham, U.K., showed a similar perinatal mortality but a higher frequency of congenital malformations, preterm delivery, large-forgestational-age infants, and fetal loss before 24 weeks' gestation in 57 pregnancies in women with type 2 diabetes compared with pregnancies in women with type 1 diabetes (3,4). In 182 pregnancies in women with type 2 diabetes compared with the general population, there was a 2.5-fold greater risk of perinatal mortality and an 11-fold greater risk of a congenital malformation (5). A study from New Zealand reported a threefold increased perinatal mortality rate in pregnancies related to type 2 diabetes compared with pregnancies related to type 1 diabetes. In addition, the study indicated that the outcome was poorer if type 2 diabetes was diagnosed during pregnancy compared with before pregnancy (6). The prevalence of type 2 diabetes in pregnancy was the highest in non-Caucasian women, who had a nonsignificantly higher HbA 1c dur...

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OBJECTIVE -To determine the influence of microalbuminuria on pregnancy outcome in women with type 1 diabetes.RESEARCH DESIGN AND METHODS -This prospective cohort study took place at the Obstetric Clinic at National University Hospital, Copenhagen, from January 1996 to February 2000. All Caucasian women with type 1 diabetes, unselected from the eastern part of Denmark, with a living fetus before 17 weeks of gestation on admission were asked to participate. For women with more than one delivery in the study period, only the first pregnancy was included. Of the remaining 246 women, 240 (98%) entered the study. They were categorized according to their urinary albumin excretion (normal urinary albumin excretion, Ͻ30 mg/24 h; microalbuminuria, 30 -300 mg/24 h; or diabetic nephropathy, Ͼ300 mg/24 h) before pregnancy or in the first trimester.RESULTS -A total of 203 women (85%) had normal urinary albumin excretion, 26 (11%) had microalbuminuria, and 11 (5%) had diabetic nephropathy. Mean HbA 1c at 2-6 weeks was 7.5% (SD 1.1), 8.1 (0.9), and 8.8 (1.3) (P Ͻ 0.001), respectively. Of all deliveries in women with normal urinary albumin excretion, microalbuminuria, and diabetic nephropathy, 35, 62, and 91% (P Ͻ 0.001), respectively, were preterm, and 2, 4, and 45% (P Ͻ 0.001), respectively, were small-for-gestational-age infants. Preeclampsia developed in 6, 42, and 64% of the women (P Ͻ 0.001), respectively. Category of urinary albumin excretion (P Ͻ 0.01) and HbA 1c at 2-6 weeks (P Ͻ 0.05) were independently associated with preterm delivery.CONCLUSIONS -The prevalence of preterm delivery is considerably increased in women with microalbuminuria, mainly caused by preeclampsia. Classification according to urinary albumin excretion and metabolic control around the time of conception are superior to the White classification in predicting preterm delivery in women with type 1 diabetes.

8 March 2011.