Fertility outcomes in women with pre-existing type 2 diabetes—a prospective cohort study

Abstract

Objective: To study childbirth and the risk of miscarriage and infertility among women who have received a diagnosis of type 2 diabetes before the start of their reproductive journey. Design: Register-based cohort study using the Sk ane Healthcare Register. Setting: All healthcare visits for the whole population of the southernmost region in Sweden over the past 20 years. Patient(s): All women who were aged 18-45 years between January 1, 1998 and December 31, 2019 and who received a clinical diagnosis of type 2 diabetes before their first childbirth, miscarriage, or infertility diagnosis (n ¼ 230) were compared with a healthcareseeking population of women without any type of diabetes, matched for calendar year and age (n ¼ 179,434). Intervention(s): None. Main Outcome Measure(s): Childbirth, miscarriage, and infertility diagnosis. Result(s): The birthrate was lower among women with type 2 diabetes (62.6% vs. 83.8%), and they were less likely to give birth (crude risk ratio [RR] ¼ 0.73, 95% confidence interval [CI]: 0.66-0.81). They had a higher risk of experiencing a miscarriage (RR ¼ 1.88, 95% CI: 1.50-2.36). The risk of infertility was increased (RR ¼ 3.44, 95% CI: 2.88-4.10) as was the risk of having infertility and not giving birth (RR ¼ 4.47, 95% CI: 3.44-5.82). All results remained the same after adjustment for polycystic ovary syndrome and obesity. Conclusion(s):Women with type 2 diabetes with onset before their reproductive journey were more often childless compared with women without diabetes and had a higher risk of experiencing both miscarriage and infertility. This patient group may be in need of targeted information regarding potential fertility issues as part of their clinical treatment. (Fertil Steril Ò 2021;116:505-13. Ó2021 by American Society for Reproductive Medicine.) El resumen está disponible en Español al final del artículo.

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