Perinatal Outcomes in a Longitudinal Birth Cohort of First Nations Mothers With Pregestational Type 2 Diabetes and Their Offspring: The Next Generation Study

Pylypjuk, Christy; Sellers, Elizabeth; Wicklow, Brandy

doi:10.1016/j.jcjd.2020.05.001

Cited by 12 publications

(20 citation statements)

References 48 publications

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“…Those deliveries requiring emergency intrapartum CS tended to have lower rates of induction of labor compared to those resulting in spontaneous vaginal delivery, thus dispelling potential concerns about a risk of CS due to induction of labor which is consistent with the literature. It was notable that fetal ultrasound in our center tended to underdiagnose fetal macrosomia compared to postnatal diagnosis using birthweights over the 90 th percentile for gestational age: this finding was consistent with another preliminary work by our team with a similar population and likely impacted by the high rates of morbid obesity in this group as well as the inherent limitations of fetal ultrasound to accurately predict newborn weight during late pregnancy [5,15]. Diagnostic thresholds that use a cut-off of 4500 grams to designate macrosomia in the newborn are also likely to underestimate the frequency of fetal overgrowth in this population or for other populations where delivery before term is undertaken [10].…”

Section: Discussionsupporting

confidence: 87%

“…Another specific concern is the 4-5 times higher rate of stillbirth for mothers with pregestational type 2 diabetes, which has prompted increased efforts to improve antenatal surveillance and maternal glycemic control [3,4]. Around the time of delivery, diabetes increases the risk of almost all peripartum complications of childbirth: induction of labor, Caesarean section (CS), operative vaginal delivery, high-degree lacerations, shoulder dystocia and related newborn injuries including asphyxia, postpartum hemorrhage, and prolonged hospital stay [3][4][5]. However, our ability to predict which patients with type 2 diabetes are most at risk of these intrapartum complications remains limited [3][4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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The Relationship between Fetal Abdominal Wall Thickness and Intrapartum Complications amongst Mothers with Pregestational Type 2 Diabetes

Isabey

Pylypjuk

2021

Journal of Diabetes Research

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Objectives. To evaluate the utility of fetal abdominal wall thickness (AWT) for predicting intrapartum complications amongst mothers with pregestational type 2 diabetes. Methods. This was a historical cohort study of pregnant mothers with pregestational type 2 diabetes delivering at a Canadian tertiary-care center between January 1, 2014, and December 31, 2018. Delivery records were reviewed to collect information about demographics and peripartum complications. Stored fetal ultrasound images from 36 weeks’ gestation were reviewed to collect fetal biometry and postprocessing measurement of AWT performed in a standardized fashion by 2 blinded and independent observers. The relationship between fetal AWT was then correlated with risk of intrapartum complications including emergency Caesarean section (CS) and shoulder dystocia. Results. 216 pregnant women with type 2 diabetes had planned vaginal deliveries and were eligible for inclusion. Mean maternal age was 31.3 years, and almost all were overweight or obese at the time of delivery (96.8%). Overall, the incidence of shoulder dystocia and emergency intrapartum CS was 7.4% and 17.6%, respectively. There was no difference in mean fetal AWT between those having a spontaneous vaginal delivery (8.2 mm (95% CI 7.9-8.5)) and those needing emergency intrapartum CS (8.1 mm (95% CI 7.4-8.8); p = 0.71 ) or shoulder dystocia (8.7 mm (95% CI 7.9-9.5); p = 0.23 ). There was strong interobserver correlation of AWT measurements ( r = 0.838 ; p < 0.00001 ). The strongest association with intrapartum complications was birthweight ( p = 0.003 ): with birthweight > 4000 grams, the relative risk of shoulder dystocia or CS is 2.75 (95% CI 1.74-4.36; p < 0.001 ). Conclusions. There was no obvious benefit of AWT measurement at 36 weeks for predicting shoulder dystocia or intrapartum CS amongst women with type 2 diabetes in our population. The strongest predictor of intrapartum complications remained birthweight, and so studies for improving estimation of fetal weight and evaluating the role of intrapartum ultrasound for predicting risk of delivery complications are still needed.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

The Relationship between Fetal Abdominal Wall Thickness and Intrapartum Complications amongst Mothers with Pregestational Type 2 Diabetes

Isabey

Pylypjuk

2021

Journal of Diabetes Research

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“…14 15 First Nations mothers and mothers of low socioeconomic status have higher rates of obesity during pregnancy 7 16 and their children, therefore, have the long-term risks associated with this. 6 Similarly, women who are more likely to smoke during pregnancy are those living in remote areas, mothers of low socioeconomic status, and First Nations mothers. 17 18 These inequalities in pregnancy outcomes may be entrenching a cycle of disadvantage due to the lifelong impacts of poor pregnancy outcomes.…”

Section: Inequalities In Pregnancy Outcomes and The Role Of Preconcep...mentioning

confidence: 99%

Health Economics and Equity in Preconception Health Care: A Systematic Review

2022

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Poor pregnancy outcomes affect a child's lifelong health and disadvantaged populations are at higher risk of poor pregnancy outcomes. Preconception care aims to improve pregnancy outcomes by managing conditions and risks prior to conception. Given known inequities in pregnancy outcomes, the adoption of preconception care may benefit disadvantaged populations. Health economics plays an important role in the implementation of interventions, as economic evaluations seek to identify the most efficient and equitable care options. This review aimed to identify the cost-effectiveness of preconception care and how equity has been considered in these evaluations. A systematic review of literature published between 2012–2022 was undertaken to identify studies that evaluate the economic outcomes of preconception care. Studies that met the inclusion criteria were manually searched for consideration of equity in the economic evaluation analysis. Costs were presented and a narrative synthesis of studies reporting on outcomes of equity was conducted. Eight studies met the inclusion criteria, and only two reported on aspects of equity, specifically ethnicity. Considering the significant disparities in pregnancy outcomes among disadvantaged populations, aspects of equity are important to consider when implementing and evaluating preconception interventions. Therefore, it is recommended that future research focuses on the cost-effectiveness of preconception care and that these evaluations incorporate aspects of equity.

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“…Along with the macrosomia, IUGR, and HDP in pregnancy, diabetes in pregnancy is associated with spontaneous abortions, a higher likelihood for Cesarean deliveries andoperative vaginal deliveries, but also higher general perinatal mortality, including perinatal asphyxia and congenital anomalies, especially involving cardiac anomalies, polycythemia, organomegaly, neonatal hypoglycemia, changes in electrolytes, and neonatal hyperbilirubinemia [ 23 , 24 , 25 , 26 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

Maternal and Fetal Outcomes among Pregnant Women with Diabetes

Gojnić

Todorović

Stanisavljević

et al. 2022

IJERPH

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The aim of this study was to examine the differences in pregnancy complications, delivery characteristics, and neonatal outcomes between women with type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), and gestational diabetes mellitus (GDM). This study included all pregnant women with diabetes in pregnancy in Belgrade, Serbia, between 2010 and 2020. The total sample consisted of 6737 patients. In total, 1318 (19.6%) patients had T1DM, 138 (2.0%) had T2DM, and 5281 patients (78.4%) had GDM. Multivariate logistic regression with the type of diabetes as an outcome variable showed that patients with T1DM had a lower likelihood of vaginal delivery (OR: 0.73, 95% CI: 0.64–0.83), gestational hypertension (OR: 0.47, 95% CI: 0.36–0.62), higher likelihood of chronic hypertension (OR: 1.88, 95% CI: 1.55–2.29),and a higher likelihood ofgestational age at delivery before 37 weeks (OR: 1.38, 95% CI: 1.18–1.63) compared to women with GDM. Multivariate logistic regression showed that patients with T2DM had a lower likelihood ofgestational hypertension compared to women with GDM (OR: 0.37, 95% CI: 0.15–0.92).Our results indicate that the highest percentage of diabetes in pregnancy is GDM, and the existence of differences in pregnancy complications, childbirth characteristics, and neonatal outcomes are predominantly between women with GDM and women with T1DM.

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Perinatal Outcomes in a Longitudinal Birth Cohort of First Nations Mothers With Pregestational Type 2 Diabetes and Their Offspring: The Next Generation Study

Cited by 12 publications

References 48 publications

The Relationship between Fetal Abdominal Wall Thickness and Intrapartum Complications amongst Mothers with Pregestational Type 2 Diabetes

The Relationship between Fetal Abdominal Wall Thickness and Intrapartum Complications amongst Mothers with Pregestational Type 2 Diabetes

Health Economics and Equity in Preconception Health Care: A Systematic Review

Maternal and Fetal Outcomes among Pregnant Women with Diabetes

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