A Population-Based Study of Diabetes during Pregnancy in Spain (2009–2015): Trends in Incidence, Obstetric Interventions, and Pregnancy Outcomes

Ana López-De-Andrés,Javier De Miguel-Diez,José J Zamorano-León,Rodrigo Jimenez-Garcia,David Carabantes-Alarcón,Valentín Hernández-Barrera,María A Palomar-Gallego,Napoleón Perez-Farinos

doi:10.3390/jcm9020582

Abstract

(1) Background: We examined trends in incidence and outcomes in women with existing type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM) and gestational diabetes mellitus (GDM) compared with a control group without diabetes. (2) Methods: This was an observational, retrospective epidemiological study using the National Hospital Discharge Database. (3) Results: There were 2,481,479 deliveries in Spain between 2009 and 2015 (5561 mothers with T1DM, 4391 with T2DM, and 130,980 with GDM). Incidence and maternal age of existing diabetes and GDM increased over time. Women with T2DM were more likely to have obstetric comorbidity (70.12%) than those with GDM (60.28%), T1DM (59.45%), and no diabetes (41.82%). Previous cesarean delivery, preeclampsia, smoking, hypertension, and obesity were the most prevalent risk factors in all types of diabetes. Women with T1DM had the highest rate of cesarean delivery (Risk Ratio (RR) 2.34; 95% Confidence Interval (CI) 2.26–2.43) and prolonged maternal length of stay. Labor induction was higher in T2DM (RR 1.99; 95% CI 1.89–2.10). Women with T1DM had more severe maternal morbidity (RR 1.97; 95% CI 1.70–2.29) and neonatal morbidity (preterm birth, RR 3.32; 95% CI 3.14–3.51, and fetal overgrowth, RR 8.05; 95% CI 7.41–8.75). (4) Conclusions: existing and GDM incidence has increased over time. We found differences in the prevalence of comorbidities, obstetric risk factors, and the rate of adverse obstetric outcomes among women with different types of diabetes. Pregnant women with diabetes have the highest risk of adverse pregnancy outcomes.

Highlights

Diabetes mellitus during pregnancy is associated with an increased risk for severe maternal and neonatal morbidity [1,2]
Gestational diabetes is associated with a greater risk of type 2 diabetes mellitus (T2DM) in the future [4] and greater neonatal morbidity when compared with pregnant women without diabetes (Odds Ratio (OR) 1.16; 95% Confidence Interval (CI) 1.04–1.30) [1]
Mean maternal age increased over time in pregnant women with Type 1 diabetes mellitus (T1DM) and gestational diabetes and was stable around 34 years old in those with T2DM

Summary

Introduction

Diabetes mellitus during pregnancy is associated with an increased risk for severe maternal and neonatal morbidity [1,2]. Gestational diabetes is associated with a greater risk of T2DM in the future [4] and greater neonatal morbidity when compared with pregnant women without diabetes (Odds Ratio (OR) 1.16; 95% Confidence Interval (CI) 1.04–1.30) [1]. Population-based studies in Spain showed that the number of deliveries in women with existing diabetes and gestational diabetes has increased between 2001 and 2008 [3,12]. In the United Kingdom, a study reported an increment in deliveries of women with existing diabetes between 1995 and 2012, and higher rates of adverse pregnancy outcomes and obstetric interventions [13]. In the United States a recent study concluded that from 2012 to 2016 the prevalence of gestational diabetes rose from 5.2% to 5.6%, and that the prevalence of existing diabetes remained unchanged at 0.8% [16]

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