Outcome of pregnancies complicated by pre‐gestational diabetes mellitus

Abstract

Pregestational diabetes mellitus (DM) is associated with adverse fetal and maternal outcomes. Studies suggest that optimal control of diabetes before and during pregnancy minimises these risks. There are few recent reviews of outcomes of pregnancies complicated by DM in Australia. Ninety-three pregnancies in women with DM at our hospital since 1989 were identified. We collected data for maternal age, type of diabetes, duration of therapy, complications of diabetes, maternal complications of pregnancy and fetal outcomes including malformations. The rate of pregnancy planning with optimal glycaemic control at conception was low in our population, particularly in patients with Type 1 diabetes. Women who smoked had worse glycaemic control, and a higher rate of miscarriage. There was a high rate of Caesarean section, particularly in those women with Type 1 diabetes (77.4%). The rate of Caesarean section was lower in planned pregnancies. There were no perinatal deaths. The number of neonates with major congenital anomalies was high (13%) in the Type 1 population. It is important to increase the rates of prepregnancy planning and to optimise glycaemic control before pregnancy. In many cases there has been a long interval between diagnosis and pregnancy, so all women with diabetes should receive counselling at frequent intervals about pregnancy and the importance of planning. Women who planned their pregnancies had improved outcomes, with decreased rate of Caesarean section, better glycaemic control and better neonatal Apgar scores. Women with diabetes should not smoke during pregnancy because of the increased risk of miscarriage and poorer glycaemic control.

Congenital anomalies in the offspring of women with Type 1, Type 2 and gestational diabetes

“…This study has confirmed the findings of other studies, that the incidence of major congenital malformations for women with pregestational diabetes is in the order of 5–10%[1–3]. The incidence was similar for women with Type 1 and Type 2 diabetes, but gestational diabetes was associated with a much lower incidence of major congenital malformations (1.4%).…”

“…Pregestational diabetes, whether Type 1 or Type 2, is associated with a two to eight‐fold increase in the rate of major congenital defects in the fetus [1–6]. This association is thought to be secondary to the teratogenic effect of hyperglycaemia in early pregnancy.…”

Preconception care for women with type 2 diabetes mellitus: A mixed-methods study of provider knowledge and practice

“…Research across Australia and internationally has established that there are low rates of preconception care among women with T2DM [3,19,20]. A recent crosssectional survey of healthcare professionals within the NT Diabetes In Pregnancy (DIP) Partnership highlighted that few women with T2DM are seen for preconception counselling [21].…”

Preconception Counseling and Type 2 Diabetes

“…The majority of studies (Table 1) 4,5, [7][8][9][10][11][12][13][14][15][16][17][18][19] report that up to 62% of women with type 1 diabetes received PC, whereas < 36% of women with type 2 diabetes received PC. In studies by Gunton et al, 4,5 the rate of women with type 1 diabetes having received PC improved significantly over time (from 18.9 to 62.5%), but a downward trend was noted in the rate for women with type 2 diabetes (from 52.6 to 36.4%). With the rising rates of obesity and type 2 diabetes in the United States and throughout the world, 6 there is a rising number of women of childbearing age with type 2 diabetes.…”

“…Gunton et al 4,5 found significantly lower rates of cesarean section in women who had PC (13.6 vs. 48%, P < 0.05; 31.6 vs. 72.7%, P = 0.0295), and GarciaPatterson et al 10 found a significantly higher rate of cesarean section in women who had PC (71 vs. 54.9%, P < 0.05). Willhoite et al 8 also reported a higher cesarean section rate in women who received PC (81 vs. 66%) that did not reach statistical significance.…”