Pregnancy outcomes in mothers with pregestational diabetes: a population-based study in North Rhine (Germany) from 1988 to 1993

Kries, Rüdiger von; Kimmerle, Renate; Schmidt, Johannes; Hachmeister, A; Böhm, O.; Wolf, Hannah

doi:10.1007/s004310050752

Cited by 56 publications

(30 citation statements)

References 16 publications

(17 reference statements)

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“…These results differ from the results of studies in the United Kingdom and Poland: congenital malformations in infants whose mothers had pre-existing diabetes were found in 9.4 and 11.2%, respectively [7,9]. On the other hand, a study from Germany showed congenital malformations in 2.1% of such infants [2]. A large prospective study done in 1990 has shown that infants of insulin-dependent mothers are 8 times more likely to have a major malformation [13].…”

contrasting

confidence: 62%

Morphological Findings in Infants and Placentas of Diabetic Mothers

Kos¹,

Vogel²

2005

Frontiers in Diabetes, 2005

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Infants of diabetic mothers have many problems, usually called diabetic embryopathy, i.e. fetopathy. Congenital malformations together with spontaneous abortions are usually summarized under the term diabetic embryopathy, while the term diabetic fetopathy encompasses increased incidence of perinatal death, increased somatic size (macrosomia) and hypertrophy of the islets of Langerhans with B cell hyperplasia and hyperinsulinaemia. Before the discovery of insulin and its widespread use in every day practice, many infants, but their mothers as well, have died during pregnancy complicated with diabetes. Close surveillance of diabetic pregnancy has resulted in a decrease of overall perinatal mortality to 2.8%, and even to less than 2% [1-3]. These figures are still 2-to 3-fold greater than in uncomplicated pregnancies. The risk of a lethal outcome for the infant depends upon the duration and intensity of the mother's diabetes and also upon the degree of blood vessel damage it has caused. Increased perinatal mortality is the result of both increased intrauterine and neonatal mortality. Thirty years ago the main causes of neonatal death in infants from diabetic pregnancies were extreme prematurity, hyaline membrane disease, pulmonary changes unrelated to hyaline membranes, congenital malformations, infections (lung infections excluded) and changes due to asphyxia [3]. Despite many advances in the last 30 years, the rate of early and late fetal death and of neonatal mortality still remains higher than in uncomplicated pregnancies [2, 4-9]. The increased risk of fetal death begins during the third trimester, increasing gradually between 30 and 40 weeks' gestation. The autopsy of stillborn infants often fails to reveal the cause of death [10]. Experiments have shown that hyperglycaemia in lambs causes hyperinsulinaemia, increased basal metabolism and hypoxaemia. We can assume that a similar reaction in human Downloaded by: Univ. of California San Diego 198.143.33.65 -8/19/2015 12:47:14 PM Kos/Vogel 128fetuses leads to an increase in cardiac output and an abundant norepinephrine excretion together with a decrease in glucagon secretion. This pathophysiological mechanism may in humans also be the cause of unexplained intrauterine deaths in diabetic pregnancies [11]. However, strict control of maternal glycaemia has significantly reduced the stillbirth rate. In diabetic pregnancies there exists an increased risk of most congenital malformations, and the term 'diabetic embryopathy and fetopathy' has been long known in medicine [12]. In a large retrospective study carried out in Washington State, USA, the prevalence of congenital malformations was compared in infants of mothers with established pre-existing diabetes, gestational diabetes and the non-diabetic control group. In infants of mothers with pre-existing diabetes the prevalence of congenital malformations was 7.2%, in those of mothers with gestational diabetes 2.8%, while it was 2.1% in infants of healthy mothers [5]. These results differ from the results of studies in ...

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confidence: 62%

Morphological Findings in Infants and Placentas of Diabetic Mothers

Kos¹,

Vogel²

2005

Frontiers in Diabetes, 2005

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“…Type I diabetes mellitus (DM) affects approximately 0.2% to 0.4% of all pregnancies [68,69]. Diabetic pregnancy is a high-risk obstetric situation [70,71]; 30% of diabetic women with no observable DR, and 70% with background diabetic retinopathy (BDR) at the inception of pregnancy develop obstetric complications [72].…”

Section: Epidemiologymentioning

confidence: 99%

Progression of Retinopathy in Type 1 Diabetic Women During Pregnancy

Kaaja¹,

Loukovaara

2007

CDR

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Progression of diabetic retinopathy (DR) occurs at least temporarily during pregnancy and postpartum. The pathogenetic mechanisms of DR progression during pregnancy are not fully understood. Several factors related to metabolic changes (hyperglycaemia), diabetes itself (duration of diabetes before conception, baseline status of DR), pregnancy physiology (hypervolaemia and hypercoagulation, impaired retinal autoregulation) and pregnancy complications (pre-eclampsia) seem to play important roles in the progression of DR during pregnancy. On the other hand, systemic angiopoietic and vasoactive factors seem to have minor role in the deterioration of DR during that time period. Good glycaemic control, normotension, lack of nephropathy as well as lack of pre-proliferative/proliferative changes of DR are good prognostic factors as regards the progression of DR during pregnancy. However, pregnancy seems to have no long-term detrimental effects as regards the progression of DR unless it has proceeded to pre-proliferative and proliferative phases.

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“…Most of the research on pregestational diabetes and pregnancy outcomes has focused on type 1 diabetes (3,4). However, in many regions of the world, the number of pregnancies in women with type 2 diabetes is exceeding that of type 1 diabetes (5,6).…”

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confidence: 99%

Outcome of Pregnancy Among Immigrant Women With Diabetes

et al. 2003

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OBJECTIVE—We studied outcome of pregnancy among immigrant women with diabetes. The women came from regions of the world with high incidence of impaired glucose tolerance and type 2 diabetes. Prevalences, secular trends, and sociodemographic risk factors of diabetes were also explored. RESEARCH DESIGN AND METHODS—Data from the Medical Birth Registry of Norway on all births from 1988 to 1998 for mothers born in South Asia and North Africa (11,268) and Norway (601,785) were analyzed. RESULTS—The prevalence of pregestational diabetes among the immigrants was 8.9/1,000 births, which was more than twice the rate among ethnic Norwegians (3.6/1,000). Time trends indicated increasing prevalences in both groups. Among the immigrants, diabetes was closely associated with maternal age. Maternal diabetes was associated with a significantly increased risk of pregnancy complications in both study groups. Increased risks were found for low birth weight, macrosomia, preterm birth, preeclampsia, and cesarean sections. Among ethnic Norwegians, maternal diabetes conferred a significantly increased risk of infant perinatal death (odds ratio 2.00, 95% CI 1,44–2.77). In the sample of immigrant women with predominantly type 2 diabetes, maternal diabetes was not significantly associated with perinatal death or congenital malformations in the offspring. CONCLUSIONS—The high prevalence of diabetes among immigrants from South Asia and North Africa represents a challenge for health care providers. To prevent adverse pregnancy outcomes and later cardiovascular and renal morbidity among these groups, early diagnosis of diabetes, adequate metabolic control, and relevant preventive measures are warranted.

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Pregnancy outcomes in mothers with pregestational diabetes: a population-based study in North Rhine (Germany) from 1988 to 1993

Cited by 56 publications

References 16 publications

Morphological Findings in Infants and Placentas of Diabetic Mothers

Morphological Findings in Infants and Placentas of Diabetic Mothers

Progression of Retinopathy in Type 1 Diabetic Women During Pregnancy

Outcome of Pregnancy Among Immigrant Women With Diabetes

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