Trends in Obstetric Intervention and Pregnancy Outcomes of Canadian Women With Diabetes in Pregnancy From 2004 to 2015

Metcalfe, Amy; Sabr, Yasser; Hutcheon, Jennifer A.; Donovan, Lois; Lyons, Janet; Burrows, Jason; Joseph, K. S.

doi:10.1210/js.2017-00376

Cited by 41 publications

(38 citation statements)

References 17 publications

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“…Our findings support that pregnancy complications are independent risk factors for singleton sPTB and iPTB, and have a larger main effect on risk of PTB than advanced maternal age . Our ratio estimates align with those reported in large, contemporary studies ranging from approximately 2‐7 for preeclampsia, 4‐11 for placental disorders, and 1‐2 for gestational diabetes depending on whether any PTB or PTB types were used . Several Doppler and histological studies have characterized how preeclampsia and placental disorders lead to sPTB, implicating a common pathophysiology of the placenta .…”

Section: Discussionsupporting

confidence: 85%

“…Comparisons to previous research are hindered by study variation. A Canadian study reported a PAF of 1.91% for gestational diabetes, which is marginally smaller than the PAFs of 2.0% for sPTB and 4.9% for iPTB reported in our study 33. However, their population included multiple gestations and stillbirths and likely has a different distribution of maternal and obstetric characteristics compared with our sample of singleton live births.…”

contrasting

confidence: 83%

“…Our ratio estimates align with those reported in large, contemporary studies ranging from approximately 2-7 for preeclampsia, 12,31 4-11 for placental disorders, 11 and 1-2 for gestational diabetes depending on whether any PTB or PTB types were used. 13,32,33 Several Doppler and histological studies have characterized how preeclampsia and placental disorders lead to sPTB, implicating a common pathophysiology of the placenta. 34 However, biologically plausible pathways from gestational diabetes to sPTB have yet to be described.…”

Section: Re Sultsmentioning

confidence: 99%

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Pregnancy complications and risk of preterm birth according to maternal age: A population‐based study of delivery hospitalizations in Alberta

Scime

Chaput

Faris

et al. 2019

Acta Obstet Gynecol Scand

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Introduction Pregnancy‐related medical complications are associated with a 2‐ to 5‐fold increased risk of preterm birth (PTB), but the nature of this etiologic relation in context with maternal factors remains poorly understood. Previous studies have generally treated maternal age as a confounder but overlooked its potential as an effect modifier, whereby the magnitude of the effect of complications on PTB could differ significantly across age groups. We investigated whether advanced maternal age (≥35 years) modified the association between pregnancy complications and PTB, and compared population‐attributable fractions of PTB from complications in women older vs younger than 35 years. Material and methods We analyzed population‐based, cross‐sectional data from the Alberta Discharge Abstract Database for women aged 18‐50 years with singleton live births in hospital between 2014 and 2017 (n = 152 246). Complications were preeclampsia, gestational diabetes, and placental disorders identified using diagnostic codes. Outcomes were spontaneous (sPTB) or iatrogenic (iPTB) PTB before 37 weeks of gestation. We estimated risk ratios and risk differences using modified Poisson and log binomial regression, respectively, adjusting for confounders (pregnancy history, comorbidities). Population‐attributable fractions estimates were calculated from risk ratios. Age modification was tested using interaction terms and Z‐tests. Results Prevalence of advanced maternal age was 19.2%. Pregnancy complications and s/iPTB were more common among women aged ≥35 years. Age modified the risk of PTB from preeclampsia only, with risk differences of 9.9% (95% CI 7.2%‐12.6%) in older women vs 6.1% (95% CI 4.8%‐7.4%) in younger women (P‐interaction = 0.012) for sPTB, and 29.5% (95% CI 26.0%‐33.1%) vs 20.8% (95% CI 18.9%‐22.6%, P‐interaction <0.001) for iPTB. Population‐attributable fractions of s/iPTB types for all complications were consistently 2%‐5% larger in women aged ≥35 years, and significantly larger for preeclampsia (sPTB: 5.1% vs 2.7%, P = 0.002; iPTB: 18.8% vs 14.0%, P < 0.001) and placental disorders (sPTB: 12.5% vs 8.7%, P < 0.001; iPTB: 13.2% vs 8.9%, P < 0.001). Conclusions Of the pregnancy complications studied, advanced maternal age only modified the association between PTB and preeclampsia, such that older women with preeclampsia have a higher risk for s/iPTB than younger counterparts. Pregnancy complications contribute to a sizable proportion of PTBs in Alberta, especially among women aged ≥35 years. Findings may inform clinical risk assessment and population‐level policy targeting PTB.

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Section: Discussionsupporting

confidence: 85%

contrasting

confidence: 83%

Section: Re Sultsmentioning

confidence: 99%

See 1 more Smart Citation

Pregnancy complications and risk of preterm birth according to maternal age: A population‐based study of delivery hospitalizations in Alberta

Scime

Chaput

Faris

et al. 2019

Acta Obstet Gynecol Scand

Self Cite

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“…Our algorithm identified 2037 references of which 17 included composite indicators corresponding to our eligibility criteria . For 5 of the 17 indicators, we included the original article or other sources which described the construction of the indicator, instead of the article from our search .…”

Section: Resultsmentioning

confidence: 99%

Composite neonatal morbidity indicators using hospital discharge data: A systematic review

Lebreton

Crenn‐Hébert

Menguy

et al. 2020

Paediatric Perinatal Epid

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Background: Neonatal morbidity is associated with lifelong impairments, but the absence of a consensual definition and the need for large data sets limit research. Objectives:To inform initiatives to define standard outcomes for research, we reviewed composite neonatal morbidity indicators derived from routine hospital discharge data. Data sources:PubMed (updated on October 12, 2018). The search algorithm was based on three components: "morbidity," "neonatal," and "hospital discharge data." Study selection and data extraction: Studies investigating neonatal morbidity using a composite indicator based on hospital discharge data were included. Indicators defined for specific conditions (eg congenital anomalies, maternal addictions) were excluded. The target population, objectives, component morbidities, diagnosis and procedure codes, validation methods, and prevalence of morbidity were extracted. Synthesis:For each study, we assessed construct validity by describing the methods used to select the indicator components and evaluated whether the authors assessed internal and external validity. We also calculated confidence intervals for the prevalence of the morbidity composite.Results: Seventeen studies fulfilled inclusion criteria. Indicators targeted all (n = 4), low-/moderate-risk (n = 9), and very preterm (VPT, n = 4) infants. Components were similar for VPT infants, but domains and diagnosis codes within domains varied widely for all and low-/moderate-risk infants. Component selection was described for 8/17 indicators and some form of validation reported for 12/17. Neonatal morbidity prevalence ranged from 4.6% to 9.0% of all infants, 0.4% to 8.0% of low-/ moderate-risk infants, and 17.8% to 61.0% of VPT infants. Conclusions:Multiple neonatal morbidity indicators based on hospital discharge data have been used for research, but their heterogeneity limits comparisons between studies. Standard neonatal outcome measures are needed for benchmarking and synthesis of research results. K E Y

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“…The above‐mentioned limitations notwithstanding, this study is the first to compare the risks of iatrogenic delivery and expectant management by diabetes type. This is important, as previous work demonstrates that obstetric outcomes and management differ among these groups and the risk of pregnancy complications differs by the type of diabetes, being much higher in women with type 1 or type 2 diabetes than in women with GDM . We also examined the risk of both maternal and infant complications.…”

Section: Discussionmentioning

confidence: 99%

Timing of delivery in women with diabetes: A population‐based study

Metcalfe

Hutcheon

Lyons

et al. 2019

Acta Obstet Gynecol Scand

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Introduction Women with diabetes, and their infants, have an increased risk of adverse events due to excess fetal growth. Earlier delivery, when fetuses are smaller, may reduce these risks. This study aimed to evaluate the week‐specific risks of maternal and neonatal morbidity/mortality to assist with obstetrical decision making. Material and methods In this population‐based cohort study, women with type 1 diabetes (n = 5889), type 2 diabetes (n = 9422) and gestational diabetes (n = 138 917) and a comparison group without diabetes (n = 2 553 243) who delivered a singleton infant at ≥36 completed weeks of gestation between 2004 and 2014 were identified from the Canadian Institute of Health Information Discharge Abstract Database. Multivariate logistic regression was used to determine the week‐specific rates of severe maternal and neonatal morbidity/mortality among women delivered iatrogenically vs those undergoing expectant management. Results For all women, the absolute risk of severe maternal morbidity/mortality was low, typically impacting less than 1% of women, and there was no significant difference in gestational age‐specific severe maternal morbidity/mortality between iatrogenic delivery and expectant management among women with any form of diabetes. Among women with gestational diabetes, iatrogenic delivery was associated with an increased risk of neonatal morbidity/mortality compared with expectant management at 36 and 37 weeks’ gestation (76.7 and 27.8 excess cases per 1000 deliveries, respectively) and a lower risk of neonatal morbidity/mortality at 38, 39 and 40 weeks’ gestation (7.9, 27.3 and 15.9 fewer cases per 1000 deliveries, respectively). Increased risks of severe neonatal morbidity following iatrogenic delivery compared with expectant management were also observed for women with type 1 diabetes at 36 (98.3 excess cases per 1000 deliveries) and 37 weeks’ gestation (44.5 excess cases per 1000 deliveries) and for women with type 2 diabetes at 36 weeks’ gestation (77.9 excess cases per 1000 deliveries) weeks. Conclusions The clinical decision regarding timing of delivery is complex and contingent on maternal‐fetal wellbeing, including adequate glycemic control. This study suggests that delivery at 38, 39 or 40 weeks’ gestation may optimize neonatal outcomes among women with diabetes.

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Trends in Obstetric Intervention and Pregnancy Outcomes of Canadian Women With Diabetes in Pregnancy From 2004 to 2015

Cited by 41 publications

References 17 publications

Pregnancy complications and risk of preterm birth according to maternal age: A population‐based study of delivery hospitalizations in Alberta

Pregnancy complications and risk of preterm birth according to maternal age: A population‐based study of delivery hospitalizations in Alberta

Composite neonatal morbidity indicators using hospital discharge data: A systematic review

Timing of delivery in women with diabetes: A population‐based study

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