Abstract
BackgroundTo date, the rates of potentially life-threatening condition (PTLC), maternal near miss (MNM) and maternal deaths in pregnant patients with type 1 diabetes mellitus (T1DM) and variables associated to it have not been studied.MethodsThis study was as a cross-sectional retrospective study conducted at São Paulo Hospital of Universidade Federal de São Paulo, a tertiary hospital that provides public medical care through the Brazilian unified health system to high-risk pregnancies. Inclusion criteria were T1DM pregnant women who delivered from January 2005 to December 2015. Three groups were established by the World Heath Organization criteria and associations were assessed using the chi-square test in between MNM and no morbidity or PLTC and no morbidity. A P value < 0.05 was considered statistically significant.ResultsThe final sample included 137 patients, 8 MNM cases (5.84%), 51 PLTC (37.23%), no cases of maternal deaths and 78 patients (56.93%) did not present any complication. Moreover, there were 122 live births, resulting in a near miss rate of 65.5 per 1.000 live births in patients with T1DM. Two of the MNM cases were for clinical criteria (uncontrollable fit in both) and laboratory criteria for the other six: one patient with severe acute azotemia (creatinine > 300 μmol/ml), one patient with severe hypoperfusion (lactate > 5 mmol/L) and four of them with loss of consciousness and the presence of glucose and ketoacids in urine. PLTC criteria were studied in MNM and PLTC cases. Prolonged hospital stay was the most prevalent PLTC criteria in both groups (100% of MNM cases and 96% of PLTC), followed by renal failure in 50% of MNM cases and severe preeclampsia in 22% of PLTC cases. This study could not find any association between prenatal factors or sociodemographic characteristics with maternal morbidity.ConclusionsMNM rate in T1DM was extremely high, and determined by complications of the primary disease or hypertensive disorders. No sociodemographic variables studied were related to maternal morbidity; therefore, we could not predict what increases MNM and PLTC in this specific population.
Highlights
To date, the rates of potentially life-threatening condition (PTLC), maternal near miss (MNM) and maternal deaths in pregnant patients with type 1 diabetes mellitus (T1DM) and variables associated to it have not been studied
No sociodemographic variables studied were related to maternal morbidity; we could not predict what increases MNM and potentially life-threatening conditions (PLTC) in this specific population
PLTC and MNM cases were identified according to World Health Organization (WHO) criteria [7], using data collected from patient medical records
Summary
The rates of potentially life-threatening condition (PTLC), maternal near miss (MNM) and maternal deaths in pregnant patients with type 1 diabetes mellitus (T1DM) and variables associated to it have not been studied. Potentially life-threatening conditions (PLTC) were defined as an extensive category of clinical conditions that can threaten a woman’s life during the same period and lead to MNM, and the term severe maternal morbidity (SMM) included both outcomes This new terminology improved studies in maternal health, whereas we can progressively study patients from PLTC to MNM and maternal death, identifying risk factors and implementing prophylactic measures in each step to avoid mortality. Maternal and neonatal morbidity in patients with type 1 diabetes mellitus (T1DM) is well documented, with higher chances of preeclampsia, preterm birth, perinatal mortality, hypoglycemia, retinopathy, hypertension, nephropathy or diabetic ketoacidosis [2, 3] On one hand these patients have reduced rate of pregnancy - partially due to lower fertility [4], but on the other hand the prevalence of T1DM is increasing among the youth [5]. Patients tend to get pregnant without controlling the baseline disease, so that obstetric care becomes even more challenging
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