St Vincent’s Declaration 10 years on: outcomes of diabetic pregnancies

Platt, Mary Jane; Stanisstreet, Martin; Casson, Ian; Howard, C. Vyvyan; Walkinshaw, Stephen; Pennycook, S; McKendrick, O M

doi:10.1046/j.1464-5491.2002.00665.x

Cited by 126 publications

(94 citation statements)

References 11 publications

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“…The current study is, as far as we know, the first to show a statistically significant excess risk of infant death in women with type 1 diabetes. The magnitude of this result is in accordance with estimates from Great Britain and Sweden, which indicated a doubled or tripled risk of infant death without reaching statistical significance [13][14][15][16]. The current study was, to our knowledge, the first since a study in the mid-1980s [14] to present data on mortality for term and preterm deliveries separately.…”

Section: Discussionsupporting

confidence: 78%

Perinatal and infant mortality in term and preterm births among women with type 1 diabetes

et al. 2011

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Aims/hypothesis The aim of this study was to estimate the risks of adverse birth outcomes such as stillbirth, infant death, preterm birth and pre-eclampsia in women with type 1 diabetes, compared with the background population. We further aimed to explore the risks of adverse birth outcomes in preterm and term deliveries separately. Methods By linkage of two nationwide registries, the Medical Birth Registry of Norway and the Norwegian Childhood Diabetes Registry, we identified 1,307 births among women with pregestational type 1 diabetes registered in the Diabetes Registry, and 1,161,092 births in the background population during the period 1985-2004. The ORs with 95% CIs for adverse outcome among women with type 1 diabetes vs the background population were estimated using logistic regression. Results The OR for stillbirth (≥22 weeks of gestation) was 3.6 (95% CI 2.5, 5.3), and for perinatal death (stillbirth or death in the first week of life) it was 2.9 (95% CI 2.0, 4.1). The OR for infant death (first year of life) was 1.9 (95% CI 1.1, 3.2). For preterm birth (< 37 weeks of gestation) and pre-eclampsia the ORs were 4.9 (95% CI 4.3, 5.5) and 6.3Electronic supplementary material The online version of this article (doi:10.1007/s00125-011-2281-7) contains peer-reviewed but unedited supplementary material, which is available to authorised users.

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Section: Discussionsupporting

confidence: 78%

Perinatal and infant mortality in term and preterm births among women with type 1 diabetes

et al. 2011

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“…Perinatal mortality was 3.1%, which was also in the same magnitude as in the national studies from Holland and Scotland (5,6) (3.2 and 2.8%, respectively). In two consecutive cohorts in the Liverpool area, U.K. (2,11), and in one cohort from Newcastle-upon-Tyne (3), perinatal mortality tended to be higher (3.6 -4.3 and 4.8%, respectively), but the difference was not statistically significant.…”

Section: 4]) (Median and Interquartile Range)mentioning

confidence: 91%

Outcomes in Type 1 Diabetic Pregnancies

et al. 2004

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OBJECTIVE -The aim of this study was to compare pregnancy outcomes in type 1 diabetic pregnancies with the background population.RESEARCH DESIGN AND METHODS -This nationwide prospective multicenter study took place in eight Danish centers treating pregnant women with type 1 diabetes during [1993][1994][1995][1996][1997][1998][1999]. A total of 990 women with 1,218 pregnancies and delivery after 24 weeks (n ϭ 1,215) or early termination due to severe congenital malformations (n ϭ 3) were included. Data were collected prospectively by one to three caregivers in each center and reported to a central registry.RESULTS -The perinatal mortality rate was 3.1% in type 1 diabetic pregnancies compared with 0.75% in the background population (RR 4.1 [95% CI 2.9 -5.6]), and the stillbirth rate was 2.1% compared with 0. 45 (4.7 [3.2-7.0]). The congenital malformation rate was 5.0% in the study population and 2.8% (1.7 [1.3-2.2]) in the background population. Six of the perinatal deaths (16%) were related to congenital malformations. Only 34% of women performed daily home monitoring of blood glucose at conception, and 58% received preconceptional guidance. Pregnancies with serious adverse outcomes (perinatal death and/or congenital malformations) were characterized by higher HbA 1c values before and during pregnancy and a lesser degree of maternal self-care and preconceptional guidance. Women who performed daily self-monitoring of blood glucose at any time during pregnancy had lower HbA 1c values than women who did not measure their daily profile. Likewise, daily self-monitoring was associated with a reduction in serious adverse outcomes. The caesarean section rate was 55.9 and 12.6%, respectively, and the risk of preterm delivery was 41.7 and 6.0%, respectively. CONCLUSIONS -Type 1 diabetic pregnancies are still complicated by considerably higher rates of severe perinatal complications compared with the background population, and women with poor self-care are at the highest risk. Adequate glycemic control using daily glucose monitoring before and during pregnancy is a crucial step toward reaching the goals of the St. Vincent declaration. Diabetes Care 27:2819 -2823, 2004I n 1989, the St. Vincent declaration (1) stated that the outcome of diabetic pregnancy should approximate that of the nondiabetic pregnancy within 5 years. Since then, four regional prospective studies from the U.K. and Finland (2-5) and two nationwide studies from Holland and France (6,7) have reported rates for perinatal mortality and/or congenital malformations, considerably higher than the background population. The number of pregnancies varied from 111 to 691. In Denmark, clinical data have been prospectively collected since 1992, which enables us to analyze data on a cohort of Ͼ1,200 consecutive pregnancies. The objective was to compare pregnancy outcomes in type 1 diabetic pregnancies with the background population. -During 1993-During -1999, all pregnancies in women with pregestational type 1 diabetes were prospectively reported to a central registry...

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“…Diabetes in pregnant women is associated with increased occurrence of both fetal and maternal adverse events, including macrosomia, congenital malformations, spontaneous abortion, perinatal mortality, and preeclampsia (1,2). The close relationship between the development of such complications and maternal hyperglycemia has been widely documented.…”

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confidence: 99%