Improved pregnancy outcomes in women with type 1 and type 2 diabetes but substantial clinic-to-clinic variations: a prospective nationwide study

Abstract

Aims/hypothesisThe aim of this prospective nationwide study was to examine antenatal pregnancy care and pregnancy outcomes in women with type 1 and type 2 diabetes, and to describe changes since 2002/2003.MethodsThis national population-based cohort included 3036 pregnant women with diabetes from 155 maternity clinics in England and Wales who delivered during 2015. The main outcome measures were maternal glycaemic control, preterm delivery (before 37 weeks), infant large for gestational age (LGA), and rates of congenital anomaly, stillbirth and neonatal death.ResultsOf 3036 women, 1563 (51%) had type 1, 1386 (46%) had type 2 and 87 (3%) had other types of diabetes. The percentage of women achieving HbA1c < 6.5% (48 mmol/mol) in early pregnancy varied greatly between clinics (median [interquartile range] 14.3% [7.7–22.2] for type 1, 37.0% [27.3–46.2] for type 2). The number of infants born preterm (21.7% vs 39.7%) and LGA (23.9% vs 46.4%) were lower for women with type 2 compared with type 1 diabetes (both p < 0.001). The prevalence rates for congenital anomaly (46.2/1000 births for type 1, 34.6/1000 births for type 2) and neonatal death (8.1/1000 births for type 1, 11.4/1000 births for type 2) were unchanged since 2002/2003. Stillbirth rates are almost 2.5 times lower than in 2002/2003 (10.7 vs 25.8/1000 births for type 1, p = 0.0012; 10.5 vs 29.2/1000 births for type 2, p = 0.0091).Conclusions/interpretationStillbirth rates among women with type 1 and type 2 diabetes have decreased since 2002/2003. Rates of preterm delivery and LGA infants are lower in women with type 2 compared with type 1 diabetes. In women with type 1 diabetes, suboptimal glucose control and high rates of perinatal morbidity persist with substantial variations between clinics.Data availabilityFurther details of the data collection methodology, individual clinic data and the full audit reports for healthcare professionals and service users are available from http://content.digital.nhs.uk/npid.

Caring for pregnant women whose diabetes antedates pregnancy: is there room for improvement?

“…In another report, a decrease over time in fetal overgrowth has been noted for women with type 1, but not type 2 diabetes [7]. Of concern, however, is that the incidence of these three major adverse outcomes was consistently greater for pregnancies in women who had pregestational diabetes than in women without diabetes during pregnancy [3,7,8].…”

“…In much of the world, a greater proportion of pregnant women with diabetes antedating pregnancy have type 2 diabetes, and the increase in the prevalence of diabetes during pregnancy is greater for type 2 (111-354%) than for type 1 (33-162%) diabetes [6][7][8] .…”

“…Populationbased studies examining trends in adverse pregnancy outcomes over long periods are sparse and there appears to be some discrepancy in findings. For example, one study [3] found an apparent decline in neonatal congenital malformations over time while another [8] did not. Likewise, a decrease in stillbirths over time was previously reported by one research group [8] but no differences were observed in another study [3].…”

“…For example, one study [3] found an apparent decline in neonatal congenital malformations over time while another [8] did not. Likewise, a decrease in stillbirths over time was previously reported by one research group [8] but no differences were observed in another study [3]. In another report, a decrease over time in fetal overgrowth has been noted for women with type 1, but not type 2 diabetes [7].…”

“…For a start, there is a need for expansion of populationbased health registries [9], as described by Murphy et al [8]. The report from the UK registry, which captures 155 maternity clinics in England and Wales [8], data from the Swedish Medical Birth Registry, which captures >98% of births [10], the Dutch registry, which collects pregnancy information from women with type 1 diabetes from all 118 hospitals in the Netherlands [11], and the Ontario, Canada database, capturing over 1,000,000 births [3], have been able to advance knowledge of the burden of disease, show improvements over time and highlight areas that still need work. Registries often collect important data variables that hospital-based databases do not contain, such as HbA 1c values, BMI and information on folic acid consumption.…”