Comparing type 1 and type 2 diabetes in pregnancy- similar conditions or is a separate approach required?

Abstract

BackgroundPregnancy in women with type 1 (T1DM) or type 2 diabetes (T2DM) is associated with increased risk. These conditions are managed similarly during pregnancy, and compared directly in analyses, however they affect women of different age, body mass index and ethnicity.MethodsWe assess if differences exist in pregnancy outcomes between T1DM and T2DM by comparing them directly and with matched controls. We also analyze the effect of glycemic control on pregnancy outcomes and analyze predictive variables for poor outcome.ResultsWe include 323 women with diabetes and 660 glucose-tolerant controls. T2DM women had higher BMI, age and parity with a shorter duration of diabetes and better glycemic control. Preeclampsia occurred more in women with T1DM only. Rates of elective cesarean section were similar between groups but greater than in controls, emergency cesarean section was increased in women with type 1 diabetes. Maternal morbidity in T1DM was double that of matched controls but T2DM was similar to controls. Babies of mothers with diabetes were more likely to be delivered prematurely. Neonatal hypoglycemia occurred more in T1DM than T2DM and contributed to a higher rate of admission to neonatal intensive care for both groups. Adverse neonatal outcomes including stillbirths and congenital abnormalities were seen in both groups but were more common in T1DM pregnancies. HbA1C values at which these poor outcomes occurred differed between T1 and T2DM.ConclusionsPregnancy outcomes in T1DM and T2DM are different and occur at different levels of glycemia. This should be considered when planning and managing pregnancy and when counseling women.

Safety of non‐insulin glucose‐lowering drugs in pregnant women with pre‐gestational diabetes: A cohort study

“…Studies at the population level have typically combined all diabetes types, thus missing any potential variability. However, pathology studies have found differences in placentation . The placentas of women with T2D present more vasculopathic abnormalities, suggesting a vascular aetiology of pregnancy complications .…”

“…34 The placentas of women with T2D present more vasculopathic abnormalities, suggesting a vascular aetiology of pregnancy complications. [34][35][36] Effects on placentation may explain the greater risk of pregnancy losses in women with T2D. The placentas of women with T1D present signs of abnormal development, 36 which might correlate with abnormal development of foetal cells and the resulting higher risk of malformations.…”

Association between maternal diabetes, being large for gestational age and breast-feeding on being overweight or obese in childhood

“…Maternal weight is an established predictor of LGA [29]. Previous studies have found women with gestational diabetes or type 2 diabetes to have higher BMI compared with women with type 1 [30][31][32]. Our finding that the rates of being overweight/obese in childhood were higher in the gestational diabetes/LGA (42.9%) and type 2/LGA (42.5%) than in the type 1/LGA (31.4%) and also in the gestational diabetes/AGA (23.9%) and type 2/AGA (26.7%) than in the type 1/AGA (21.2%) supports the increasing emphasis on maternal weight as a major contributor to excessive weight in children [33][34][35].…”

High insulin impaired ovarian function in early pregnant mice and the role of autophagy in this process

“…Women with T2DM deliver earlier and are at an increased risk of injuries from delivering a large infant [8]. Additionally, the live birth rates of women with T2DM were significantly lower than those of the general population [9]. However, the mechanism of this phenomenon is still unclear.…”