A comparison of Type 1 and Type 2 diabetes in pregnancy

Abstract

CELESTE DURNWALD, ALBERT FRANCO, MARK LANDON, The Ohio State University, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Columbus, Ohio OBJECTIVE: To compare maternal and perinatal outcomes of women with Type 1 and Type 2 diabetes mellitus. STUDY DESIGN: A 3 year observational study of women with Type 1 and 2 diabetes mellitus (DM). Clinical characteristics, diabetic therapy and perinatal/neonatal outcomes were prospectively collected. RESULTS: 70 women with Type 1 DM and 67 women with Type 2 DM were evaluated. Women with Type 1 DM were younger (26.7 vs 31.3 years, p!0.0001) and more likely to have vascular disease (17.1 vs 3%, p=0.009). Racial distribution, insurance status, overweight/obese pregravid BMI (R25kg/m) and preexisting hypertension were similar between groups. Both preterm delivery (36.7 vs 37.5 weeks, p=0.01) and preeclampsia (30 vs 11.9%, p=0.01) were more common in Type 1 DM. Glycemic control was similar in Type 1 and 2 DM (HgBA1C 6.5 vs 6.1, p=0.07). No difference in total insulin requirements was observed between groups in 1st (0.77 vs 0.64 units/kg, p=0.12), 2nd (0.95 vs 0.91 units/kg, p=0.69), and 3rd (1.06 vs 1.15 units/kg, p=0.44) trimesters of pregnancy, however, the rate of increase in insulin dosage was lower in Type 1 compared with Type 2 DM between 1st and 2nd trimester (0.16 vs 0.28 units/kg, p=0.03), 2nd and 3rd trimester (0.11 vs 0.25 units/kg, p=0.01). A higher rate of NICU admission (28.6 vs 12%, p=0.02) and longer hospital stay (6.7 vs 3.6 days, p=0.002) was present in infants of Type 1 DM. After controlling for gestational age at delivery, rate of NICU admission was not different between groups (p=0.24). Rates of LGA and macrosomia were also similar in Type 1 and 2 DM (30 vs 29.9%, p=1.0 and 14.3 vs 23.9%, p=0.19, respectively), as were birth weight (3286 vs 3466 grams, p=0.12) and ponderal index (2.70 vs 2.68, p=0.88). CONCLUSION: Perinatal outcomes of well controlled Type 1 DM are comparable to those of Type 2 DM, except for a higher rate of preeclampsia and earlier gestational age at delivery. Remarkably, total insulin requirements were similar between Type 1 and 2 DM, although rate of increase in insulin dosage between trimesters is significantly less in Type 1 DM.