Maternal and Fetal Outcome in Women with Type 2<i>Versus</i>Type 1 Diabetes Mellitus: A Systematic Review and Metaanalysis

Balsells, Montserrat; García‐Patterson, Apolonia; Gich, Ignasi; Corcoy, Rosa

doi:10.1210/jc.2009-1231

Cited by 255 publications

(224 citation statements)

References 44 publications

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“…Increased efforts are also needed to educate and empower women with type 2 diabetes, who have the lowest rates of attendance for preconception care (19 vs. 35% in women with type 1 diabetes) (26). Women with type 2 diabetes tend to be of lower socioeconomic status and include many ethnic minorities and new immigrants, making the challenges of preconception awareness and care more difficult (27).…”

Section: Discussionmentioning

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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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: Discussionmentioning

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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“…Pregestational BMI and gestational weight gain in nulliparous women with type 1 DM has been reported to be associated with an increased rate of cesarean section [22]; therefore, diet therapy may play an important role in the management of pregnant women with DM. A meta-analysis by Basells et al showed that HbA1c levels at booking were higher in type 1 DM patients, with similar congenital malformation rates in women with type 1 and type 2 DM, and lower rates of diabetic ketoacidosis and cesarean section in type 2 DM patients than in type 1 DM patients [23]. This metaanalysis summarized pregnancy outcomes in women with type 1 and type 2 DM worldwide over 20 years; however, the progress and improvement in the management for diabetes was not evaluated by this study.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy outcomes in women with type 1 and type 2 diabetes mellitus in a retrospective multi-institutional study in Japan

et al. 2014

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“…Secondly, regular effective follow-up reduces the risk of undiagnosed type 2 diabetes predating a subsequent pregnancy, and the increased risk to mother and foetus associated with such an event (3).…”

Section: Introductionmentioning

confidence: 99%

ATLANTIC DIP: simplifying the follow-up of women with previous gestational diabetes

Noctor

Crowe

Carmody

et al. 2013

European Journal of Endocrinology

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Objective: Previous gestational diabetes (GDM) is associated with a significant lifetime risk of type 2 diabetes. In this study, we assessed the performance of HbA1c and fasting plasma glucose (FPG) measurements against that of 75 g oral glucose tolerance testing (OGTT) for the follow-up screening of women with previous GDM. Methods: Two hundred and sixty-six women with previous GDM underwent the follow-up testing (mean of 2.6 years (S.D. 1.0) post-index pregnancy) using HbA1c (100%), and 75 g OGTT (89%) or FPG (11%). American Diabetes Association (ADA) criteria for abnormal glucose tolerance were used. Design, cohort study, and results: The ADA HbA1c high-risk cut-off of 39 mmol/mol yielded sensitivity of 45% (95% CI 32, 59), specificity of 84% (95% CI 78, 88), negative predictive value (NPV) of 87% (95% CI 82, 91) and positive predictive value (PPV) of 39% (95% CI 27, 52) for detecting abnormal glucose tolerance. ADA high-risk criterion for FPG of 5.6 mmol/l showed sensitivity of 80% (95% CI 66, 89), specificity of 100% (95% CI 98, 100), NPV of 96% (95% CI 92, 98) and PPV of 100% (95% CI 91, 100). Combining HbA1c R39 mmol/mol with FPG R5.6 mmol/l yielded sensitivity of 90% (95% CI 78, 96), specificity of 84% (95% CI 78, 88), NPV of 97% (95% CI 94, 99) and PPV of 56% (95% CI 45, 66). Conclusions: Combining test cut-offs of 5.6 mmol/l and HbA1c 39 mmol/mol identifies 90% of women with abnormal glucose tolerance post-GDM (mean 2.6 years (S.D.1.0) post-index pregnancy). Applying this follow-up strategy will reduce the number of OGTT tests required by 70%, will be more convenient for women and their practitioners, and is likely to lead to increased uptake of long-term retesting by these women whose risk for type 2 diabetes is substantially increased.

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Maternal and Fetal Outcome in Women with Type 2VersusType 1 Diabetes Mellitus: A Systematic Review and Metaanalysis

Abstract: Despite a milder glycemic disturbance, women with type 2 DM had no better perinatal outcomes than those with type 1, indicating that type 2 DM in pregnancy is a serious condition.

Cited by 255 publications

References 44 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

Pregnancy outcomes in women with type 1 and type 2 diabetes mellitus in a retrospective multi-institutional study in Japan

ATLANTIC DIP: simplifying the follow-up of women with previous gestational diabetes

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