Abstract
BackgroundGlycaemic control in women with diabetes is critical to satisfactory pregnancy outcome. A systematic review of two randomised trials concluded that there was no clear evidence of benefit from very tight versus tight glycaemic control for pregnant women with diabetes.MethodsA systematic review of observational studies addressing miscarriage, congenital malformations and perinatal mortality among pregnant women with type 1 and type 2 diabetes was carried out. Literature searches were performed in MEDLINE, EMBASE, CINAHL and Cochrane Library. Observational studies with data on glycated haemoglobin (HbA1c) levels categorised into poor and optimal control (as defined by the study investigators) were selected. Relative risks and odds ratios were calculated for HbA1c and pregnancy outcomes. Adjusted relative risk estimates per 1-percent decrease in HbA1c were calculated for studies which contained information on mean and standard deviations of HbA1c.ResultsThe review identified thirteen studies which compared poor versus optimal glycaemic control in relation to maternal, fetal and neonatal outcomes. Twelve of these studies reported the outcome of congenital malformations and showed an increased risk with poor glycaemic control, pooled odds ratio 3.44 (95%CI, 2.30 to 5.15). For four of the twelve studies, it was also possible to calculate a relative risk reduction of congenital malformation for each 1-percent decrease in HbA1c, these varied from 0.39 to 0.59. The risk of miscarriage was reported in four studies and was associated with poor glycaemic control, pooled odds ratio 3.23 (95%CI, 1.64 to 6.36). Increased perinatal mortality was also associated with poor glycaemic control, pooled odds ratio 3.03 (95%CI, 1.87 to 4.92) from four studies.ConclusionThis analysis quantifies the increase in adverse pregnancy outcomes in women with diabetes who have poor glycaemic control. Relating percentage risk reduction in HbA1c to relative risk of adverse pregnancy events may be useful in motivating women to achieve optimal control prior to conception.
Highlights
Glycaemic control in women with diabetes is critical to satisfactory pregnancy outcome
The presence of diabetes is said to increase the risk of congenital malformation, the risk of stillbirth, and the risk of neonatal death [2,3,4,5,6,7] These disappointing data are in contrast to the optimism of the 1989 St Vincent's Declaration that proposed as a five year target that the outcome of pregnancy should approximate that of the non-diabetic pregnancy [8]
The objective of the study was to perform a systematic review of observational studies to investigate and quantify the risk of adverse pregnancy outcomes in pregnant women with diabetes in relation to glycaemic control, whether poor or optimal
Summary
Glycaemic control in women with diabetes is critical to satisfactory pregnancy outcome. The presence of diabetes is said to increase the risk of congenital malformation (by ten-fold), the risk of stillbirth (by five-fold), and the risk of neonatal death (by three-fold) [2,3,4,5,6,7] These disappointing data are in contrast to the optimism of the 1989 St Vincent's Declaration that proposed as a five year target that the outcome of pregnancy should approximate that of the non-diabetic pregnancy [8]. Glycated haemoglobin (HbA1c) reflects long-term glycaemic control and is a more accurate and stable measure than fasting blood glucose levels [9]. It tracks well over time in individuals with diabetes and has less variability than fasting blood glucose
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
