Improvement in pregnancy‐related outcomes in the offspring of diabetic mothers in Bavaria, Germany, during 1987–2007

Beyerlein, Andreas; Kries, Rüdiger von; Hummel, Michael; Lack, Nicholas; Schießl, Barbara; Giani, Guido; Icks, Andrea

doi:10.1111/j.1464-5491.2010.03109.x

Cited by 27 publications

(28 citation statements)

References 16 publications

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“…This is consistent with other studies that continue to show elevated perinatal mortality rates in women with pre-GDM captured past 2003 (13,14,32). Two studies that looked at the trend over time showed a nonsignificant decline in stillbirths/perinatal mortality (13,14).…”

Section: Discussionsupporting

confidence: 80%

“…There is little data on whether the rates of these serious outcomes have changed over time in women with diabetes. Only two studies have looked at trends in outcomes in women with diabetes over the last decade, in Germany (data up to 2004) and the U.K. (data up to 2007), and both failed to find significant decreases in perinatal mortality or congenital anomalies (13,14). Using unique population-based databases that link maternal and fetal health records, the aim of this population-based study was to compare rates of serious perinatal outcomes between women with and without diabetes in pregnancy, explore whether these rates have changed over time, and relate these rates to the underlying trends in rates of diabetes in pregnancy over the past 14 years.…”

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confidence: 99%

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Trends in Incidence of Diabetes in Pregnancy and Serious Perinatal Outcomes: A Large, Population-Based Study in Ontario, Canada, 1996–2010

et al. 2014

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OBJECTIVEWomen with diabetes in pregnancy have high rates of pregnancy complications. Our aims were to explore trends in the incidence of diabetes in pregnancy and examine whether the risk of serious perinatal outcomes has changed. RESEARCH DESIGN AND METHODSWe performed a population-based cohort study of 1,109,605 women who delivered in Ontario, Canada, between 1 April 1996 and 31 March 2010. We categorized women as gestational diabetes (GDM) (n = 45,384), pregestational diabetes (pre-GDM) (n = 13,278), or no diabetes (n = 1,050,943). The annual age-adjusted rates of diabetes in pregnancy were calculated, and rates of serious perinatal outcomes were compared between groups and by year using Poisson regression. RESULTSThe age-adjusted rate of both GDM (2.7-5.6%, P < 0.001) and pre-GDM (0.7-1.5%, P < 0.001) doubled from 1996 to 2010. The rate of congenital anomalies declined by 23%, whereas the rate of perinatal mortality did not change significantly. However, compared with women with no diabetes, women with pre-GDM and GDM faced an increased risk of congenital anomalies (relative risk 1.86 [95% CI 1.49-2.33] and 1.26 [1.09-1.45], respectively), and perinatal mortality remained elevated in women with pre-GDM (2.33 [1.59-3.43]). CONCLUSIONSThe incidence of both GDM and pre-GDM in pregnancy has doubled over the last 14 years, and the overall burden of diabetes in pregnancy on society is growing. Although congenital anomaly rates have declined in women with diabetes, perinatal mortality rates remain unchanged, and the risk of both remains significantly elevated compared with nondiabetic women. Increased efforts are needed to reduce these adverse outcomes.Diabetes in pregnancy is becoming an increasingly growing concern as the prevalence of diabetes continues to rise (1). Women with diabetes who become pregnant have an increased risk of pregnancy complications (2-7), including serious perinatal outcomes such as stillbirth, perinatal mortality, and major congenital malformations. Hyperglycemia in the period around conception and the first weeks

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Section: Discussionsupporting

confidence: 80%

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confidence: 99%

Trends in Incidence of Diabetes in Pregnancy and Serious Perinatal Outcomes: A Large, Population-Based Study in Ontario, Canada, 1996–2010

et al. 2014

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“…Numerous studies indicate that the rates of perinatal complications among type 1 diabetic patients are still substantially higher than those of the general population [4][5][6][7][8][9][10][11]. Only a few centres have shown improvement in the outcomes of type 1 diabetic pregnancies in recent decades [12,13].…”

Section: Introductionmentioning

confidence: 99%

Trends in maternal BMI, glycaemic control and perinatal outcome among type 1 diabetic pregnant women in 1989–2008

et al. 2012

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Aims/hypothesis Our objective was to examine the trends in prepregnancy BMI and glycaemic control among Finnish type 1 diabetic patients and their relation to delivery mode and perinatal outcome. Methods We analysed the obstetric records of 881 type 1 diabetic women with a singleton childbirth during 1989-2008. Maternal prepregnancy weight and height were obtained from the maternity cards, where they are recorded as reported by the mother. Results Maternal BMI increased significantly during 1989-2008 (p<0.001). The mean HbA 1c in the first trimester remained unchanged, but the midpregnancy and the last HbA 1c before delivery increased (p00.009 and 0.005, respectively). Elective Caesarean sections (CS) decreased (p for trend <0.001), while emergency CS increased (p for trend <0.001). The mean umbilical artery (UA) pH decreased in vaginal deliveries (p for trend <0.001). The frequency of UA pH <7.15 and <7.05 increased (p for trend <0.001 and 0.008, respectively). The macrosomia rate remained at 32-40%. Neonatal intensive care unit (NICU) admissions increased (p for trend 0.03) and neonatal hypoglycaemia frequency decreased (p for trend 0.001). In multiple logistic regression analysis, maternal BMI was associated with macrosomia and NICU admission. The last HbA 1c value before delivery was associated with delivery before 37 weeks' gestation, UA pH <7.15, 1 min Apgar score <7, macrosomia, NICU admission and neonatal hypoglycaemia. Conclusions/interpretation Self-reported pregestational BMI has increased and glycaemic control during the second half of pregnancy has deteriorated. Poor glycaemic control seems to be associated with the observed increases in adverse obstetric and perinatal outcomes.

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“…Das zunehmende präkonzeptionelle Körpergewicht und Lebensalter der Frauen sind wichtige Trigger für die steigende Inzidenz der Erkrankung [1,2]. [4].…”

Section: Pathophysiologieunclassified

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2014

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Improvement in pregnancy‐related outcomes in the offspring of diabetic mothers in Bavaria, Germany, during 1987–2007

Abstract: Although the risk of adverse pregnancy outcomes is still increased in diabetic mothers, considerable improvement has been achieved. We hypothesize that this improvement is possibly due to improved diabetes care.

Cited by 27 publications

References 16 publications

Trends in Incidence of Diabetes in Pregnancy and Serious Perinatal Outcomes: A Large, Population-Based Study in Ontario, Canada, 1996–2010

Trends in Incidence of Diabetes in Pregnancy and Serious Perinatal Outcomes: A Large, Population-Based Study in Ontario, Canada, 1996–2010

Trends in maternal BMI, glycaemic control and perinatal outcome among type 1 diabetic pregnant women in 1989–2008

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