Perinatal mortality in Type 2 diabetes mellitus

Cundy, Tim; Gamble, Greg; Townend, K.; Henley, Patrick; MacPherson, Paul; Ab, Roberts

doi:10.1046/j.1464-5491.2000.00215.x

Cited by 235 publications

(122 citation statements)

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“…In addition, the study indicated that the outcome was poorer if type 2 diabetes was diagnosed during pregnancy compared with before pregnancy (6). The prevalence of type 2 diabetes in pregnancy was the highest in non-Caucasian women, who had a nonsignificantly higher HbA 1c during pregnancy (3,4,6).The aims of the present study were to evaluate the frequency of maternal complications and serious adverse fetal outcome in a group of women with type 2 diabetes who gave birth between 1996 and 2001 and to compare the outcome in this group to the outcome in three other groups, namely a group of women with type 1 diabetes who gave birth at our clinic in the same period, the background population in the same period, and a group of women with type 2 diabetes who gave birth at our clinic during 1982-1990 (7). To our knowledge, this is the first report that compares outcome in pregnancies in a recent group of women with type 2 diabetes to a former group of women with type 2 diabetes.…”

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confidence: 99%

Poor Pregnancy Outcome in Women With Type 2 Diabetes

et al. 2005

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OBJECTIVE -To evaluate the perinatal outcome and the frequency of maternal complications in pregnancies of women with type 2 diabetes during 1996 -2001.RESEARCH DESIGN AND METHODS -Medical records of 61 consecutive singleton pregnancies in women with type 2 diabetes from 1996 to 2001 were studied. Pregnancy outcome was compared with that of pregnant women with type 1 diabetes during 1996 -2000, the background population, and pregnant women with type 2 diabetes during 1980 -1992 from the same department.RESULTS -The perinatal mortality in pregnancies complicated by type 2 diabetes (4/61, 6.6%) was increased four-and ninefold, respectively, and the rate of major congenital malformations (4/60, 6.7%) was more than doubled, although not statistically significant, compared with type 1 diabetic pregnancies and the background population. The glycemic control was similar or better in women with type 2 diabetes compared with women with type 1 diabetes. Multivariate logistic regression analysis in the pooled group of pregnancies with pregestational diabetes from 1996 to 2001 showed that high HbA 1c at admission and type 2 diabetes were independently associated with a serious adverse fetal outcome (perinatal mortality and/or major congenital malformations). The perinatal mortality and the rate of major congenital malformations in type 2 diabetic pregnancies have increased during the last decade.CONCLUSIONS -The perinatal outcome of pregnancies in women with type 2 diabetes during 1996 -2001 is poor. It is worse than the outcome of pregnancies in women with type 1 diabetes and the background population in the same period, as well as in women with type 2 diabetes studied during 1982-1990. Diabetes Care 28:323-328, 2005T he prevalence of type 2 diabetes is increasing rapidly in all age-groups. In line with this, it is a general clinical observation that the number of pregnant women with pregestational type 2 diabetes has become more frequent in the recent years; however, little knowledge exists concerning the prevalence and outcome of these pregnancies (1,2).A study from Birmingham, U.K., showed a similar perinatal mortality but a higher frequency of congenital malformations, preterm delivery, large-forgestational-age infants, and fetal loss before 24 weeks' gestation in 57 pregnancies in women with type 2 diabetes compared with pregnancies in women with type 1 diabetes (3,4). In 182 pregnancies in women with type 2 diabetes compared with the general population, there was a 2.5-fold greater risk of perinatal mortality and an 11-fold greater risk of a congenital malformation (5). A study from New Zealand reported a threefold increased perinatal mortality rate in pregnancies related to type 2 diabetes compared with pregnancies related to type 1 diabetes. In addition, the study indicated that the outcome was poorer if type 2 diabetes was diagnosed during pregnancy compared with before pregnancy (6). The prevalence of type 2 diabetes in pregnancy was the highest in non-Caucasian women, who had a nonsignificantly higher HbA 1c dur...

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Poor Pregnancy Outcome in Women With Type 2 Diabetes

et al. 2005

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“…After excluding women with undiagnosed pregestational diabetes, the risk of perinatal death in deliveries after 37 weeks in the insulin-treated group was no longer increased, although excess risk persisted in the non-insulin-treated group. Cundy et al reported that, after excluding newly diagnosed type 2 diabetes from the GDM group, the perinatal mortality rate was no longer increased [29]. The increased risk of perinatal mortality observed in the group of women with GDM treated exclusively by diet is more difficult to explain.…”

Section: Discussionmentioning

confidence: 99%

Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012

Billionnet¹,

Mitanchez

Weill³

et al. 2017

Diabetologia

390

282

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Aims/hypothesis The aim of this study was to assess the risk of adverse perinatal outcomes in gestational diabetes mellitus (GDM) in a large national cohort. Methods All deliveries taking place after 22 weeks in France in 2012 were included by extracting data from the hospital discharge database and the national health insurance system. The diabetic status of mothers was determined by the use of glucose-lowering agents and by hospital diagnosis. Outcomes were analysed according to the type of diabetes and, in the GDM group, whether or not diabetes was insulin-treated. Results The cohort of 796,346 deliveries involved 57,629 (7.24%) mothers with GDM. Mother-infant linkage was obtained for 705,198 deliveries. The risks of adverse outcomes were much lower with GDM than with pregestational diabetes. After limiting the analysis to deliveries after 28 weeks to reduce immortal time bias, the risks of preterm birth (OR 1. were increased in women with GDM compared with the non-diabetic population. Higher risks were observed in women with insulin-treated GDM than those with diet-treated GDM. After limiting the analysis to term deliveries, an increased risk of perinatal mortality was observed. After excluding women suspected to have undiagnosed pregestational diabetes, the risk remained moderately increased only for those with diet-treated GDM (OR 1.3 [95% CI 1.0, 1.6]). Conclusions/interpretation GDM is associated with a moderately increased risk of adverse perinatal outcomes, which is higher in insulin-treated GDM than in non-insulintreated GDM for most outcomes.

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“…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). Diabetes outcomes are consistently worse in those of lower socioeconomic status (28,29), and the increased rates of serious outcomes in women may also be due to non-health care factors, such as poor nutrition and smoking.…”

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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Perinatal mortality in Type 2 diabetes mellitus

Cited by 235 publications

References 20 publications

Poor Pregnancy Outcome in Women With Type 2 Diabetes

Poor Pregnancy Outcome in Women With Type 2 Diabetes

Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012

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

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