Abstract
BackgroundType 1 diabetes mellitus in pregnant women is associated with an increased risk of congenital malformations, obstetric complications, neonatal morbidity, and mortality. Our aim was to evaluate which factors from the first trimester of pregnancy have a significant impact on the pregnancy outcomes of women with type 1 diabetes.MethodsWe included 94 pregnant women with type 1 diabetes in this study. In these patients, we analyzed the influence of several diabetes-related parameters on the pregnancy outcome. We compared the parameters between two cohorts: those with successful pregnancies and those with adverse pregnancy outcomes, defined as spontaneous abortion or congenital malformations. The influence of several factors on the pregnancy outcome was assessed using multivariate and univariate logistic regressions.ResultsThe prevalence of adverse pregnancy outcomes was 28.7%, and was associated with poorer glycemic control (p <0.001), lower frequency of daily self-monitoring tests (p <0.001), smoking status (p <0.001), alcohol consumption (p <0.001), increased prevalence of chronic complications of diabetes, and the presence of ketosis. However, the adverse outcomes were not significantly associated with age, duration of diabetes, presence of thyroid disease, or body mass index. Furthermore, planned pregnancy was found to be a significant protective factor (odds ratio, 0.15; p <0.001).ConclusionThese results indicate that by carefully planning the pregnancy, ensuring optimal glycemic control, and eliminating habitual risk factors, the fetal risk in pregnancies among women with type 1 diabetes may decrease to a value similar to that noted in women without diabetes.
Highlights
Type 1 diabetes mellitus in pregnant women is associated with an increased risk of congenital malformations, obstetric complications, neonatal morbidity, and mortality
Achieving optimal glycemic control without the occurrence of hypoglycemic events is one of the most important factors influencing pregnancy prognosis [5]. This is challenging because pregnancy itself results in an increase in the insulin resistance among women, even in women with Type 1 diabetes mellitus (T1DM)—some reports have cited an increase in the daily insulin need of up to 40%
We evaluated the differences in age, duration of diabetes, Hemoglobin A1c (HbA1c) level and body mass index (BMI), smoking status, alcohol consumption, presence of thyroid disorders, chronic complications of diabetes, and the occurrence of ketosis in the first trimester of pregnancy or preeclamspia between the two groups
Summary
Type 1 diabetes mellitus in pregnant women is associated with an increased risk of congenital malformations, obstetric complications, neonatal morbidity, and mortality. Type 1 diabetes mellitus (T1DM) in pregnant women is associated with a significant increase in the risk of congenital malformations, obstetric complications, neonatal morbidity, and mortality [1]. The frequency of major congenital malformations among fetuses of mothers with T1DM was estimated to be approximately 6–10%, which represents a 2–5-fold increase compared to the abnormalities noted in mothers without diabetes [2] These increases in risk are primarily related to poor glycemic. Achieving optimal glycemic control without the occurrence of hypoglycemic events is one of the most important factors influencing pregnancy prognosis [5] This is challenging because pregnancy itself results in an increase in the insulin resistance among women, even in women with T1DM—some reports have cited an increase in the daily insulin need of up to 40%. Changes in the diet during pregnancy, should be considered as factors that make good glycemic control difficult to achieve
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