French Multicentric Survey of Outcome of Pregnancy in Women With Pregestational Diabetes

Abstract

OBJECTIVE -To evaluate perinatal outcome in pregnancies in women with type 1 and type 2 diabetes and the influence of preconception care 10 years after the St. Vincent's declaration. RESEARCH DESIGN AND METHODS-A cross-sectional study was conducted in 12 perinatal centers in France in 2000 -2001. The main investigated outcomes were perinatal mortality, major congenital malformations, and preterm delivery.RESULTS -Among 435 single pregnancies, 289 (66.4%) were from women with type 1 and 146 (33.6%) from women with type 2 diabetes. Perinatal mortality rate was 4.4% (0.7% national rate), severe congenital malformations rate was 4.1% (2.2% national rate), and preterm delivery rate was 38.2% (4.7% national rate). Preconception care was provided in 48.5% women with type 1 diabetes and in 24.0% women with type 2 diabetes. Women whose first trimester HbA 1c was Ͼ8% had higher rates of perinatal mortality (9.2 vs. 2.5%; odds ratio 3.9; 95% CI 1.5-9.7; P Ͻ 0.005), major congenital malformations (8.3 vs. 2.5%; 3.5; 1.3-8.9; P Ͻ 0.01), and preterm delivery (57.6 vs. 24.8%; 1.4; 1.1-1.7; P Ͻ 0.005) than those with first trimester HbA 1c Ͻ8%. These results are similar to those reported in France in 1986 -1988.CONCLUSIONS -Pregnancies in women with diabetes are still poorly planned and complicated by higher rates of perinatal mortality and major congenital malformations. Despite knowledge of the importance of intensified glycemic control before pregnancy, reaching the St. Vincent's target needs further implementation in France. Diabetes Care 26:2990 -2993, 2003I n 1989, representatives of the government health departments and patients' organizations from all of the European countries met with diabetes experts under the aegis of the Regional Offices of the World Health Organization and the International Diabetes Federation in St. Vincent, Italy, and identified goals to be achieved in the treatment of diabetes (1). One of the declared aims was that within 5 years, "pregnancy outcome of diabetic women should approximate that of the nondiabetic women." Previous studies have shown that such results may be obtained in women with type 1 diabetes by providing effective preconception care and intensive support to improve glycemic control before and during the whole pregnancy (2-5). However, this was achieved in selected populations and in specialized units. By contrast, several surveys done in nonselected, geographically based populations showed that the prognosis of pregnancy in women with type 1 diabetes remains poorer than that of the general population (6,7). Moreover, new issues have been raised by the increasing prevalence of type 2 diabetes in pregnancy (8). Particularly, type 2 diabetes often remains unrecognized, and the rate of perinatal mortality in women with type 2 diabetes may be higher than in those with type 1 diabetes (9).In 1986 -1988, a multicenter survey of pregnancies in women with diabetes was performed in France (10). It essentially showed that the rate of perinatal mortality was 1.9% in women with type 1 diabete...

Obstetric and Perinatal Outcomes in Type 1 Diabetic Pregnancies

“…Many of the preterm deliveries in other studies were performed before the start of or after induction of labor (13). Perinatal mortality in type 1 diabetic pregnancies in Sweden has decreased from 3.1% in 1982–1985 (1) to 2.0% in the present study, and it is in the lower range of previously recorded rates, varying from 1.3 to 6.6% (4–6,13,18,22). Nevertheless, perinatal mortality in type 1 diabetic women exceeds that in control women by 4 times, mainly because of the increased risk for stillbirth.…”

Preconception Care Education for Women With Diabetes: A Systematic Review of Conventional and Digital Health Interventions

“…All studies used appropriate study designs, namely, randomized controlled trials, before and after, and cohort studies but lacked details on blinding and allocation concealment. Although small sample sizes [10,11,12], selection bias [10,12,58], and confounding [12,56,57] were underlying issues of weakness within most studies, these were acknowledged and addressed by the authors.…”

“…Of the included studies, 2 [56,57] explored the effect of a PCC educational intervention on levels of glycosylated hemoglobin (HbA1c). Boulot et al [56] assigned women with T1DM and T2DM to either an intervention group (n=175) where they received the PCC education before conception, or to a control group (n=360) receiving standard care.…”

Objectives and methods of the ORCHESTRA FOUNDATION Registry study: a multicenter observational study of the use of insulin pump therapy in pregnant women with type 1 diabetes mellitus in Poland.

“…High HbA 1c levels in early pregnancy are associated with complications such as congenital malformations and miscarriage, while hyperglycemia in late pregnancy is associated with macrosomia leading to birth injury and caesarean section, other fetal morbidity [1,[1][2][3][4][5][8][9][10][11], and a potential predisposition to type 2 diabetes and obesity [12,13].…”

“…Risks for the mother include miscarriage, hypoglycemia, ketoacidosis, preeclampsia, polyhydramnios, and premature or obstructed labor, which may necessitate caesarean section. Fetuses and neonates are at increased risk of congenital malformations, perinatal mortality, birth injuries, macrosomia, neonatal hypoglycemia, jaundice, and respiratory distress [1][2][3][4][5][6][7][8].…”