Maternal and fetal outcomes of pregnant women with type 1 diabetes, a national population study.

Shu-Fu Lin,Shang-Hung Chang,Meng-Jiun Chiou,Chang-Fu Kuo

doi:10.18632/oncotarget.20952

Shu-Fu Lin, Shang-Hung Chang + Show 2 more

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https://doi.org/10.18632/oncotarget.20952

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Journal: Oncotarget	Publication Date: Sep 16, 2017
Citations: 16	License type: cc-by

Affiliation: Chang Gung Memorial Hospital

Abstract

Pregnancy in women with type 1 diabetes is associated with poor maternal and neonatal outcomes. However, the risk of these outcomes has never been evaluated in an Asian national population. In this work, we report the maternal and fetal outcomes of pregnant women with type 1 diabetes in Taiwan. A total of 2,350,339 pregnancy records created between 2001 and 2012 were obtained from the National Health Insurance database and analyzed. Here, 630 pregnancy records were identified in women having type 1 diabetes. Compared with pregnant women without type 1 diabetes, pregnant women with the disease showed increased risk of multiple adverse outcomes, including preeclampsia, eclampsia, cesarean delivery, adult respiratory distress syndrome, pulmonary edema, sepsis, chorioamnionitis, pregnancy-related hypertension, puerperal cerebrovascular disorders, acute renal failure, and shock. Fetuses of type 1 diabetic mothers were at increased risk of stillbirth, premature birth, large for gestational age, low birth weight, and low Apgar score. Of the studied endpoints, only preeclampsia showed an improvement in the late period (2011–2012) when compared with the early period (2001–2010). These findings reveal that pregnant women with type 1 diabetes are at significantly increased risk of developing many adverse maternal and fetal outcomes. Therefore, pregnancy outcomes in women with type 1 diabetes should be improved.

Highlights

The incidence of type 1 diabetes is about 0.1– 36.5/100,000 persons with a 3.2%–5.3% annual increase rate in North America, Europe, and Asia [1]
These findings reveal that pregnant women with type 1 diabetes are at significantly increased risk of developing many adverse maternal and fetal outcomes
Multiple comorbidities were more common in the pregnancies of type 1 diabetic women than in the pregnancies of the controls; these comorbidities included myocardial infarction (0.32% vs. 0%), congestive heart failure (0.79% vs. 0.06%), peripheral vascular disease (0.95% vs. 0.08%), cerebrovascular disease (0.32% vs. 0.07%), chronic pulmonary disease (1.75% vs. 0.61%), rheumatologic disease (1.27% vs. 0.68%), ulcer disease (5.87% vs. 0.97%), renal disease (1.75% vs. 0.04%), malignancy (0.32% vs. 0.08%), and mild liver disease (3.17% vs. 0.28%), demonstrating type 1 diabetic women had higher rates of a variety of disease before pregnancy compared with the control group

Summary

Introduction

The incidence of type 1 diabetes is about 0.1– 36.5/100,000 persons with a 3.2%–5.3% annual increase rate in North America, Europe, and Asia [1]. The increasing number of patients with type 1 diabetes presents a significant public health challenge. The onset of type 1 diabetes usually occurs before the age of 30. This disease could affect many women of reproductive age. Pregnancies in women with type 1 diabetes are often associated with increased risks of multiple maternal and fetal adverse outcomes. Improving care for diabetic patients to reduce a risk of associated complications is the goal of diabetes management [2]

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