Abstract
Objective. To assess the incidence of adverse pregnancy outcome in native and nonnative Dutch women with pregestational type 2 diabetes (T2D) in a multicenter study in The Netherlands. Methods. Maternal characteristics and pregnancy outcome were retrospectively reviewed and the influence of ethnicity on outcome was evaluated using independent t-test, Mann-Whitney U-test, and chi-square test. Results. 272 pregnant women (80 native and 192 non-native Dutch) with pregestational T2D were included. Overall outcome was unfavourable, with a perinatal mortality of 4.8%, major congenital malformations of 6.3%, preeclampsia of 11%, preterm birth of 19%, birth weight >90th percentile of 32%, and a Caesarean section rate of 42%. In nonnative Dutch women, the glycemic control was slightly poorer and the gestational age at booking somewhat later as compared to native Dutch women. However, there were no differences in incidence of preeclampsia/HELLP, preterm birth, perinatal mortality, macrosomia, and congenital malformations between those two groups. Conclusions. A high incidence of adverse pregnancy outcomes was found in women with pregestational T2D, although the outcome was comparable between native and non-native Dutch women. This suggests that easy access to and adequate participation in the local health care systems contribute to these comparable outcomes, offsetting potential disadvantages in the non-native group.
Highlights
Pregestational diabetes mellitus comprises both type 1 and type 2 diabetes mellitus
All women with pregestational type 2 diabetes are referred to hospital care in the Netherlands. 272 women in whom a singleton pregnancy progressed beyond 20 weeks of gestation and who delivered between January 1997 and August 2009 were included in an anonymised database and subsequently evaluated
A total of 287 singleton pregnancies in women with pregestational type 2 diabetes were referred to our centers. 15 pregnancies ended before 20 weeks of gestation, leaving 272 ongoing pregnancies and deliveries (11 in Amersfoort, 28 in Groningen, 72 in Utrecht, 65 in Amsterdam, 39 in Rotterdam, 10 in Heerlen, and 47 in the Hague)
Summary
Pregestational diabetes mellitus comprises both type 1 and type 2 diabetes mellitus. Pregestational type 1 diabetes mellitus is clearly associated with an increased incidence of adverse maternal, fetal, and neonatal outcome [1,2,3,4], and several studies in the last two decades have shown that pregestational type 2 diabetes poses an emerging problem, with pregnancyISRN Obstetrics and Gynecology outcomes at least as poor as in women with type 1 diabetes [5,6,7,8,9]. To add to the problem, pregestational type 2 diabetes is encountered frequently in specific subpopulations in north-western Europe, such as recently migrated women from Africa, Asia, and the Middle East [11]. These women are possibly more prone to suboptimal participation in the health care system because of frequently existing language barriers, generally less financial resources, and low education levels in those immigrant groups. To elucidate more comprehensively the potential impact of ethnic origin (and their possible accompanying problems) on pregnancy outcome, we performed a retrospective multicentre study to assess maternal, fetal, and neonatal outcome in a large group of native and a mixture of nonnative Dutch women with pregestational type 2 diabetes from different hospitals spread throughout the Netherlands. We hypothesized that nonnative Dutch women with type 2 diabetes had a more unfavourable pregnancy outcome as compared to native Dutch women with type 2 diabetes
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