Diabetes Pregnancy Outcomes Research Articles

Outcome of insulin requiring diabetic pregnancies at the Al Corniche Hospital.

The aim of this study was assess the outcome of diabetic pregnancies requiring insulin under the care of a Combined DiabeticTeam and to evaluate the necessity of pre-pregnancy counseling. This is a prospective study undertaken for a 2 year period(Jan 2001 to Dec 2002) at Al Corniche Hospital, Abu Dhabi. Three hundred and eighty six pregnant diabetic womenrequiring insulin at varying gestations were looked after by Combined Diabetic Team (Team “0”) during the pregnancy andearly postpartum period, and then re-transferred back to original teams. Audit forms with comprehensive details weremaintained and data were doubly checked with the Main Delivery Unit computer data/statistics register. Main outcomemeasures were compliance to Combined Diabetic Clinic, control of Diabetes with home monitoring. Perinatal mortality rate,congenital fetal anomalies and attitude of patient to pre and post pregnancy counseling were also assessed. Out of 386 women156 ( 40.2%) were UAE patients. Grandmultiparity was 16 (4.14%). Highest parity was 16+2. Only 47 (12%) patients startedpregnancy with normal BMI while rest were overweight to obese. 322 (83.4%) were compliant to Combined Diabetic Clinic,358 (92.7%) self-injected with insulin while 325 (84.1%) did home-monitoring. Caesarian section rate was 48.4%. Grossperinatal mortality rate was 22.8/ 1000. 16 babies had congenital anomalies. Contraception was accepted by 46%, and morethan 50% defaulted Postnatal Clinic. In conclusion, maternal and perinatal outcome was good, pre pregnancy counseling wasdifficult as most pregnancies are unplanned, postnatal counseling is more relevant in our setup of diverse ethnic andgeographical population.

Congenital Anomalies and First Life Year Surveillance in Type 1 Diabetic Births

Outcomes of diabetic pregnancies have improved, but the rate of congenital anomalies (CA) has not changed for several years. In addition, perinatal mortality still is three to five times higher than in a nondiabetic population. Reported prevalence rates for CA in diabetic births range from 2% to 10%. The authors have now combined data from four Finnish national registers to determine the frequency and type of CA and mortality from 22 weeks' gestation to age 1 year in births where the mother had a diagnosis of Type 1 diabetes. A total of 954 insulin-treated women were included in the study. The control population numbered 318,560 nondiabetic singleton deliveries taking place during the same period (1991-1995). The rate of CA in diabetic births was 629 per 10,000. Forty-one newborn infants had isolated anomalies, and 13 had multiple anomalies. Five others had a genetic syndrome, and one had a syndrome of unknown origin. Cardiac anomalies were most frequent and usually were isolated anomalies. Next most frequent were genitourinary tract and musculoskeletal anomalies, which were mostly multiple. Mothers of malformed infants were significantly younger than the others, but comparable numbers in the two groups were primiparas and smoked in the first trimester. Abnormal presentations were more prevalent when the fetus was malformed. There was no difference in birth weight adjusted for gestational age. Nearly two thirds of infants with CA were boys. Intrauterine and infant deaths were 2.5-fold more frequent in diabetic cases, with the greatest difference in the postneonatal period. Three of 12 perinatal deaths were due to CA. The risk of CA remains relatively high in offspring of mothers with Type 1 diabetes. Deaths seem to be shifting from the early neonatal period to the postneonatal phase.

Maternity services for women with diabetes in the UK

Diabetic pregnancy is high risk in those regions within the UK that have reported on such an outcome. There is a paucity of information about diabetic pregnancy outcome in the rest of the UK but it seems appropriate to assume that poor outcome is widespread. Previously reports have highlighted problems with the delivery of preconception care and the lack of agreement about the screening and diagnosis of gestational diabetes. The provision of maternity services for women with diabetes in the UK is reviewed. Service development is traced from the 1980s to more recent surveys from Scotland and the former Northern region of England. Service provision has improved over the years in those regions that have agreed and audited standards for provision of care. There is a lack of information about current services within the UK but this will be partly addressed by the forthcoming survey of organization of services co-ordinated by the Confidential Enquiry into Stillbirths and deaths in Infancy (CESDI), which will survey England, Wales and Northern Ireland. In Scotland the Scottish Intercollegiate Guidelines 'Management of diabetes in pregnancy' has been implemented and audited. A similar guideline of agreed standards of care is needed for the rest of the UK.

St Vincent’s Declaration 10 years on: outcomes of diabetic pregnancies

To monitor pregnancies in women with pregestational Type 1 diabetes for pregnancy loss, congenital malformations and fetal growth parameters, in a geographically defined area in the north west of England. Population cohort study of 547 pregnancies in women with Type 1 diabetes from maternity clinics in 10 centres over a 5-year period (1995-1999 inclusive). Main outcome measures were numbers and rates of miscarriages, stillbirths, neonatal and post-neonatal deaths; prevalence of congenital malformations; birth weight in relation to gestational age. Among 547 pregnancies, there were six (1.1%) pairs of liveborn twins, 439 (80.3%) liveborn singletons; 72 (13.2%) spontaneous abortions, 14 (2.6%) stillbirths and 16 (2.9%) terminations. Four of the terminations were performed because of congenital malformations. Both the stillbirth rate (30.1/1000 total births (95% confidence interval (CI) 16.6-50.0)), and prevalence of congenital malformations (84.3/1000 live births (95% CI 60.3-113.8)) were significantly higher than the local population (P < 0.001). When corrected for gestational age, mean birth weight in the sample was 1.3 sd greater than that of infants of non-diabetic mothers (P = 0.12). Infants with congenital malformations weighed less than those without. In an unselected population, the infants of women with pregestational Type 1 diabetes mellitus have 6.4 times the reported risk of a congenital malformation and 5.1 times the reported risk of perinatal mortality than infants in the general population. Further improvements in the management of diabetes and pregnancy in these women are needed if the St Vincent's Declaration target is to be met.

Normalization of pregnancy outcome in pregestational diabetes through functional insulin treatment and modular out‐patient education adapted for pregnancy

To investigate whether modular out-patient group education for flexible, Functional Insulin Treatment (FIT) adapted for pregnancy can eliminate diabetes-associated neonatal complications in pregestational diabetes. Outcome analysis of the modular out-patient group education and FIT based on separate insulin dosages for fasting, eating or correcting hyperglycaemia in 76 consecutive pregnancies (in 20 cases first after conception) of 59 patients with pregestational diabetes (Type 1 diabetes, n = 54). (a) diabetic pregnancies: historical controls; (b) non-diabetic pregnancies: retrospective case-controlled study; (c) population-based data of all Austrian newborns registered within the respective time period. HbA1c of 113 +/- 18% of mean value (= 100%) of non-diabetic, non-pregnant population (103 +/- 14% during the last pregnancy trimester), and self-monitored blood glucose of 5.6 +/- 0.7 mmol/l (5.3 +/- 0.7 mmol/l during the last trimester) was achieved throughout all FIT pregnancies. Severe hypoglycaemia occurred in 14 pregnancies. The gestational age at delivery was 39.2 +/- 1.5 weeks (four cases (5.4%) < 37 weeks) with a birth weight of 3305 +/- 496 g. Four newborns (5.3%) were above the 90th, and nine (11.8%) below the 10th percentile for weight of reference population-based data. Hypoglycaemia was recorded in six newborns (8%). Malformations were found in two infants whose mothers booked for diabetes FIT education only after conception. The caesarean delivery rate was 25%. In comparison with historical diabetic pregnancy controls we demonstrated a reduction in major complications, and compared with non-diabetic women, a lowering of diabetes-related neonatal complication rates to general population levels. Structured, comprehensive, modular out-patient group education promoting self-choice of insulin dose for flexible, normal eating prior to conception normalizes pregnancy outcome in diabetes.

A uniform regimen enables decentralized care of diabetic pregnancies.

A nationwide recommendation to standardize the care of diabetic pregnancies in different hospitals was given in Finland in 1993. The Medical Birth Register (MBR) was used to investigate whether these recommendations have been accepted and how they have affected the outcome of newborns. Data on 1442 singleton pregnancies complicated by insulin-treated diabetes in 1991-1995 were obtained from the MBR. The incidence of insulin treatment during pregnancy was 4.5 per 1000 births. Sixty-six per cent (n = 954) of all women had Type 1 diabetes. During the study period, the number of deliveries managed in tertiary centres decreased from 59% to 47% (95% confidence interval [CI] 39-58%) and care was more often carried out on an out-patient basis. The perinatal mortality rate (>or= 28 weeks of gestation) declined from 19.3 to 8.2/1000, being 12.6/1000 in the whole diabetic population and 5.5/1000 in the general population (95% CI 3.4-8.8/1000). The risk was especially increased in insulin-treated gestational diabetic (GDM) pregnancies (14.3/1000). The proportion of macrosomic newborns (31.7%) in diabetic women was significantly higher than among the general population (3.2%) (95% CI 27.0-33.9%). The decentralization and change-over to a mainly out-patient basis of management does not appear to have increased the number of cases of adverse outcome of diabetic pregnancy when patients have been selected to the appropriate level of care. The risks in insulin-treated GDM pregnancies were almost similar to Type 1 diabetes. To succeed, there must be a standardized care programme, continuous education and motivated personnel.

Vitamin C and Glycohemoglobin Revisited

Blood glucose (BG) concentrations averaged over a 2- to 3-month period are represented by blood glycohemoglobin (GHb) as a percentage of total hemoglobin. Strict glycemic control is important to the successful outcome of diabetic pregnancy and in avoiding development of many diabetic complications (1). Hyperglycemia in nondiabetics is a major risk factor in cardiovascular disease and cancer (2). Thus, knowledge of an individual’s true GHb value is vital. This need has prompted continuing investigations of potential interferences in GHb assays (3)(4), including conflicting reports on the effect of vitamin C on GHb (5)(6)(7). …

Factors predicting peri- and neonatal outcome in diabetic pregnancy

A population-based birth cohort including 296 consecutive type 1 diabetic births in a geographically defined catchment area was used to evaluate factors predicting poor perinatal and neonatal outcome. Though perinatal mortality has decreased (17.1/1000 births at 28 or more weeks of gestation), the neonatal morbidity rate still remains high despite improved maternal metabolic control and developed antepartum surveillance. Poor glycemic control during the first weeks of pregnancy was the most important risk factor (relative risk (RR) 2.91; 95% confidence interval (CI) 1.29-6.55) predicting adverse neonatal events such as long (>10 days) stay in the neonatal unit, malformation or perinatal death. The risk was further increased in cases of severe diabetes (White class F-R; RR 2.75; 95% CI 1.59-4.76) and primiparity (RR 1.64; 95% CI 1.02-2.65). By evaluating these risk factors at the first antenatal visit, a subgroup with a particular need of counselling and intensive feto-maternal monitoring can be identified.

Outcome of Diabetic Pregnancy With Spontaneous Labour After 38 Weeks

Previously, the risk of intrauterine death in term infants of diabetic mothers led to elective delivery at 38 weeks, after confirmation that the lungs were mature. This study looked at perinatal outcomes in 148 women with well-controlled insulin-dependent diabetes who were allowed to enter labor spontaneously. All of them had reached 38 weeks with a live fetus, no obstetrical complications, and fasting blood glucose levels of 3 to 5 mM/liter (with 2-hour postprandial levels <7 mM/liter) through most of the pregnancy. One-third of the group were primigravidas. Half of the women delivered between 38 and 39 weeks’ gestation, and the rest delivered at 40 to 42 weeks’ gestation. Instrumental delivery was performed in 9 percent of cases, and cesarean delivery was performed in 7 percent. The two perinatal deaths yielded a perinatal mortality rate of 13.5 per 1000. Twenty-one infants, 14 percent of those born, required admission to a special care unit. The major differences from the general hospital population were a higher rate of operative delivery in labor (7 vs. 3.4 percent) and a higher proportion of newborn infants weighing 4 kg or more (33 vs. 18 percent). Nevertheless, there was only one case of shoulder dystocia in the diabetic group. In a larger group of 373 insulin-dependent diabetic women, from whom the study population was selected, the perinatal mortality was 3-fold greater than in the general hospital population (32 vs. 10.6 per 1000). In the well-controlled diabetic patients, the last glycosylated hemoglobin level before delivery did not predict either high birth weight or the need for cesarean delivery. Vaginal delivery is the norm in well-controlled women with insulin-dependent diabetes who are allowed to enter labor spontaneously after 38 weeks’ gestation. Perinatal morbidity and mortality are not excessive, and the risk of shoulder dystocia is not increased. Ir J Med Sci 1999;168:160–163

Pregnancy outcome of diabetic pregnancy in a developing country

International Journal of Gynecology & ObstetricsVolume 70, Issue S3 p. C47-C47 Free communication Diabetes and pregnacy Pregnancy outcome of diabetic pregnancy in a developing country L.A. Banu, L.A. BanuSearch for more papers by this author L.A. Banu, L.A. BanuSearch for more papers by this author First published: 10 December 2003 https://doi.org/10.1016/S0020-7292(00)81581-7AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume70, IssueS32000Pages C47-C47 RelatedInformation

How useful is glycated haemoglobin in predicting the outcomes of diabetic pregnancies?

International Journal of Gynecology & ObstetricsVolume 70, Issue S3 p. C47-C47 Free communication Diabetes and pregnancy How useful is glycated haemoglobin in predicting the outcomes of diabetic pregnancies? P. Scriven, P. ScrivenSearch for more papers by this authorR. Searle, R. SearleSearch for more papers by this authorP. Sinha, P. SinhaSearch for more papers by this authorF. Fairly, F. FairlySearch for more papers by this author P. Scriven, P. ScrivenSearch for more papers by this authorR. Searle, R. SearleSearch for more papers by this authorP. Sinha, P. SinhaSearch for more papers by this authorF. Fairly, F. FairlySearch for more papers by this author First published: 10 December 2003 https://doi.org/10.1016/S0020-7292(00)81579-9AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume70, IssueS32000Pages C47-C47 RelatedInformation

Outcome of diabetic pregnancy with spontaneous labour after 38 weeks.

One hundred and forty-eight patients with well controlled insulin dependent diabetes that were allowed to labour spontaneously from 1981 to 1994 were reviewed. There were 2 perinatal deaths, giving a perinatal mortality rate of 13.5/1000. One hundred and twenty-four patients (84 per cent) had a normal vaginal delivery, 13 (9 per cent) forceps delivery and 11 (7 per cent) caesarean section. Twenty-one infants (14 per cent) required admission to a Special Care Baby Unit. One third of infants weighed 4 Kg or more, however there was only 1 case of shoulder dystocia. We compared these results with those of the general hospital population of 1987. The 2 main differences are; 1) the Caesarean section rate in labour was higher for this diabetic group than for the general hospital population, 7 per cent versus 3.4 per cent, 2) the birth weight was heavier, 33 per cent of infants of the diabetic group weighed 4 Kg or more versus 18 per cent of the general hospital population. The other parameters were comparable. We conclude that conservative management of pregnancy in well controlled diabetic women is advantageous, resulting in a high vaginal delivery rate without an increase in shoulder dystocia, and a low perinatal morbidity and mortality rate.

Prospective population based survey of outcome of pregnancy in diabetic women: results of the Northern Diabetic Pregnancy Audit, 1994

Objective: To determine whether the St Vincent declaration (1989) target of diabetic pregnancy outcome approximating non-diabetic pregnancy outcome is near to being achieved.Design: Prospective collection of population based information on...

Glycosylated Hemoglobin Predicts Pregnancy Morbidity in Diabetics

The objective of this study was to evaluate the correlation of initial glycosylated hemoglobin levels and adverse outcome in diabetic pregnancies. The medical records of 260 consecutive pregnancies in diabetic women were reviewed; 97 pregestational diabetic women form the basis of this study. Information obtained was initial glycosylated hemoglobin value and gestational age when tested, adverse pregnancy outcome (major congenital malformations, spontaneous abortion ≤24 weeks, fetal death after 24 weeks), and normal outcome. Groups were subdivided by initial glycosylated hemoglobin levels of ≤9%, >9≤12%, and >12%. Data were analyzed using one-way analysis of variance (ANOVA), Fisher's exact test, t-tests, and receiver-operator characteristics (ROC) curves. Compared to pregnancies with normal outcome the glycosylated hemoglobin was higher in pregnancies with major congenital malformations (P < 0.0001), spontaneous abortions (P < 0.0001), and fetal death (P = 0.001). Adverse outcomes were related to the clas...

Doppler velocimetry and the assessment of fetal well-being in normal and diabetic pregnancies.

Doppler ultrasound has been proposed as a useful addition to antepartum testing in high-risk pregnancies. Increased placental resistance has been associated with underlying placental vascular disease, as well as abnormal fetoplacental blood flow. Since pregnancies complicated by diabetes are at risk for these complications, the application of Doppler ultrasonography for such pregnancies has been evaluated by several investigators.Multiple investigations have examined the relationship between maternal blood glucose levels and abnormal Doppler waveforms in women with diabetes. Of the nine published studies, four found a correlation between Doppler indices and glucose control, as measured by mean blood glucose levels and glycosylated hemoglobin levels, while five did not. However, this apparent discrepancy may be explained by the fact that the majority of women studied were in good or excellent control, as this is currently the accepted standard of care. In fact, the one study performed in primarily non-diabetic women demonstrated that increases in maternal plasma glucose concentrations of 30 mg/dl were followed by significant rises in the mean pulsatility index in both the umbilical and carotid arteries. More dramatic was the finding by most investigators that systolic/diastolic (S/D) ratios in third-trimester umbilical arteries were elevated in women with evidence of diabetic microvascular disease. Elevated third-trimester S/D ratios were associated with adverse maternal and perinatal outcomes in these women, specifically pre-eclampsia and intrauterine growth retardation. In conclusion, although elevated Doppler indices correlated with adverse outcomes in diabetic pregnancies, Doppler indices may be elevated in the otherwise uncomplicated diabetic patient with associated microvascular disease and with a normal outcome. Therefore, the Doppler ultrasound assessment of fetal well-being in diabetic pregnancies must be interpreted with caution.

Outcome of diabetic pregnancy and glucose intolerance in pregnancy: an audit of fetal loss in Newcastle General Hospital 1977–1990

The outcome of pregnancy complicated by established diabetes or gestational glucose intolerance (diabetes mellitus or impaired glucose tolerance) is compared with the outcome of non-diabetic pregnancy. Between 1977 and 1990, 169 pregnancies in women with established diabetes and 61 pregnancies in women with gestational glucose intolerance were referred to the Newcastle General Hospital. The perinatal mortality (PNM) in women with established diabetes was 8.2 1000 and the viable fetal loss (sum of PNM, neonatal and infant loss) was 41 1000 . The PNM in women with gestational glucose intolerance was 49.2 1000 and the viable fetal loss was 82 1000 . The PNM in the background population was 11.6 1000 . The fetal malformation rate was 17.3% for established diabetes, 9.8% in gestational glucose intolerance and 2.2% in the background population. Fetal abnormality remains the major cause of viable fetal loss in both established diabetes and gestational glucose intolerance.

Genetic and non genetic factors in the outcome of diabetic pregnancy

In insulin-dependent diabetes mellitus, maternal Phosphoglucomutase genotype is a predictor of fetal macrosomia much more important than quality of metabolic control during pregnancy. In gestational diabetes and in non insulin-dependent diabetes, on the contrary, the most important predictor is the metabolic control of diabetes.

Diabetic Embryopathy Studies With Animal and In Vitro Models

Diabetic pregnancy is associated with an increased risk for fetal maldevelopment for a largely unknown reason. A decade ago, Norbert Freinkel suggested that the altered fuel mixture offered to the growing conceptus may be the key to most of the changes in the embryogenesis of diabetic pregnancy. He coined the term fuel-mediated teratogenesis. During early pregnancy, periods of maternal hyper- and hypoglycemia may cause marked changes in the availability of glucose to the conceptus. Also, increased concentrations of lipids, notably ketone bodies, and branched-chain amino acids in the maternal circulation contribute to a changed fuel mixture for the embryo. In a recent experimental study of diabetic rats, it was found that the maternal metabolism of all three major classes of nutrients and maternal somatic growth during gestation covaried with the development of the embryo. Consequently, the maintenance of normal concentrations of metabolites from all nutrient classes may be important for prevention of adverse fetal outcome in diabetic pregnancy. In vitro, a high glucose concentration causes embryonic dysmorphogenesis by generation of free oxygen radicals. An enhanced production of such radicals in embryonic tissues may be directly related to an increased risk of congenital malformations in diabetic pregnancy. Thus, the notion that alterations in the net transfer of cellular fuels from the diabetic mother to her offspring may cause embryonic dysmorphogenesis, which suggests that combustion of the fuel may produce compounds that impair embryonic development, has obtained experimental support. If this is also true for human diabetic pregnancy, it has therapeutic implications.

Multicenter Survey of Diabetic Pregnancy in France

To describe the medical care and outcome of diabetic pregnancy and gestational diabetes in France and study their associations with glycemic control. We performed a multicenter prospective survey with systematic collection of clinical and biological data (HbA1c analysis in a central laboratory) at five successive examinations and consecutive recruitment of women at any stage of pregnancy in 46 specialized centers from all parts of France. Pregnancies were followed to the end. There were 483 single pregnancies (232 women with insulin-dependent diabetes mellitus [IDDM], 78 with non-insulin-dependent diabetes mellitus [NIDDM], and 173 with gestational diabetes mellitus [GDM]), and 11 twin births (8 IDDM, 3 GDM). We observed 30 abortions (6%), 8 perinatal deaths (1.8%, 4 IDDM, 4 GDM), and 13 congenital malformations (3%). In the 11 twin pregnancies, there were 7 congenital malformations. Premature births and cesarean sections were found very frequently (42 and 61% IDDM, 29 and 55% NIDDM, 22 and 32% GDM, respectively). In the three groups, birth weight adjusted for gestational age was much greater than national reference values. HbA1c levels during the first trimester were significantly higher in women who aborted (mean +/- SE 7.1 +/- 0.4 vs. 5.6 +/- 0.1%, P less than 0.001) and those who gave birth to malformed infants (6.8 +/- 0.4 vs. 5.9 +/- 0.1%, P less than 0.05). Perinatal mortality was slightly higher in diabetic women than the general population (1.8 vs. 1.2%), but the prematurity rate was much higher, possibly due to an interventionist policy in some centers. Fetal loss and congenital malformations were associated with poor glycemic control.

Diabetes mellitus in pregnancy. management and outcome of diabetic pregnancies in the state of Hesse, F.R.G.; a five-year-survey

From 1982 to 1986, data of 446 pregnancies in diabetic women were compared to equivalent information on 111390 unselected non-diabetic pregnancies with the help of the Hessische Perinatalstudie (Hessian Perinatal Study, HEPS), a computerized system of collecting information on obstetrical care in the state of Hesse, F.R.G. Patient histories, pregnancy risks, birth risks, fetal outcome and maternal well-being were evaluated to survey the current situation of diabetic pregnancies in the specific constellation of widely decentralized obstetrical management and to point out possible benefits of stronger centralization of these high-risk pregnancies. Perinatal mortality in children of diabetic mothers (4.89%) remains substantially higher than in children of non-diabetic mothers (0.63%), with two thirds of the fetal loss occurring before birth. Infant morbidity, including macrosomia, shows the same impact of maternal diabetes. Maternal post-partum morbidity is increased in diabetic women. 37.9% of children of diabetic mothers were delivered in obstetrical units equipped for maximal care, 17.5% in primary care level hospitals. Perinatal mortality and morbidity as well as maternal complications indicate that diabetic women should receive obstetrical care in those centers that can provide all the necessary facilities.