Fetal and maternal outcomes in Indo-Asian compared to Caucasian women with diabetes in pregnancy

Abstract

Maternal and fetal complications are increased when pregnancy is complicated by diabetes, and this may be further influenced by racial and cultural differences. We examined fetal and maternal outcomes in Indo-Asian and Caucasian women attending the same antenatal diabetes service to see if there were any differences. Women with diabetes mellitus (type 1, type 2 and gestationally-acquired disease) complicating pregnancy, registered at the combined diabetes/antenatal clinic of this University teaching hospital over the period 1990-1998 were included. Fetal outcomes examined were miscarriage <24 weeks, stillbirths, neonatal deaths up to 28 days of life, perinatal mortality, congenital malformations and size for gestational age. Maternal outcomes examined were rates of caesarean section and vaginal deliveries, and number of pre-term deliveries <37 completed weeks of gestation. Outcomes for Indo-Asian and Caucasian women were similar, with a take-home baby rate of 96% and 92%, respectively. There was no perinatal mortality in Indo-Asian women, who were more likely to have a vaginal delivery and less likely to have a baby large for gestational age. Pregnancies complicated by type 2 diabetes in both groups pose the greatest threat to a successful pregnancy outcome. Indo-Asian and Caucasian women attending the same antenatal diabetes service have comparable outcomes. Attendance for pre-pregnancy care needs to be encouraged to combat the high early pregnancy loss and congenital malformation rate identified, particularly in those with type 2 disease, irrespective of ethnicity.

Poor Pregnancy Outcome in Women With Type 2 Diabetes

“…However, compared with our well-characterized population of pregnant women with type 1 diabetes, women with type 2 diabetes had comparable or better glycemic metabolic control but nevertheless a poorer pregnancy outcome. A few other studies find tendencies toward higher HbA 1c and fructosamine, among women with type 1 diabetes compared with women with type 2 diabetes, but only in the first part of pregnancy (4,6,19). This indicates that factors in addition to glycemic control are related to the poor outcome of pregnancies complicated by type 2 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 during pregnancy (3,4,6).…”

“…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 during pregnancy (3,4,6).The aims of the present study were to evaluate the frequency of maternal complications and serious adverse fetal outcome in a group of women with type 2 diabetes who gave birth between 1996 and 2001 and to compare the outcome in this group to the outcome in three other groups, namely a group of women with type 1 diabetes who gave birth at our clinic in the same period, the background population in the same period, and a group of women with type 2 diabetes who gave birth at our clinic during 1982-1990 (7). To our knowledge, this is the first report that compares outcome in pregnancies in a recent group of women with type 2 diabetes to a former group of women with type 2 diabetes.…”

“…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).…”

Racial Disparities in Perinatal Outcomes Among Women with Gestational Diabetes

“…12 Some data specific to women with GDM have suggested that adverse outcome risk may also vary by race/ethnicity. [13][14][15] Findings conflict, however, and recent data suggest the magnitude of racial/ethnic differences is small, particularly when individual, more narrowly defined racial/ethnic groups are evaluated. 16,17 The association of race/ethnicity with complications of GDM and the role GDM treatment may play thus remain unclear.…”