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Has the pregnancy outcome of women with pregestational diabetes mellitus improved in ten years?


Authors: Daniela Čechurová 1;  Michal Krčma 1;  Zdeněk Jankovec 1;  Jiří Dort 2;  Jan Turek 3;  Silvie Lacigová 1;  Zdeněk Rušavý 1
Authors‘ workplace: Diabetologické centrum I. interní kliniky LF UK a FN Plzeň, přednosta prof. MUDr. Martin Matějovič, Ph. D. 1;  Neonatologické oddělení FN Plzeň, primář doc. MUDr. Jiří Dort, Ph. D. 2;  Gynekologicko-porodnická klinika LF UK a FN Plzeň, přednosta doc. MUDr. Zdeněk Novotný, CSc. 3
Published in: Vnitř Lék 2015; 61(2): 101-105
Category: Original Contributions

Overview

Introduction:
In spite of progress in medicine, studies from a number of countries indicate steadily increased risk of perinatal morbidity and mortality in the offspring of diabetic mothers. No data regarding the pregnancy outcome in women with diabetes mellitus type 1 and 2 (pregestational DM) have been published in the Czech Republic. The aim of the study was to evaluate the pregnancy course of women with pregestational DM and outcome of their offspring and to assess whether it has improved in ten years.

Methods:
A retrospective evaluation of pregnancy outcome of pregestational DM women followed up in the University Hospital Pilsen in years 2000–2009 (Group A, n = 107) and comparison with the period 1990–1997 (Group B, n = 39) were performed. Wilcoxon non-paired test, contingency tables, step-wise logistic regression and step-wise linear multiple regression methods were used for statistical analyses.

Results:
Data is presented as median (interquartile range). Women from the Group A were older 28 (25, 31) vs 25 (22, 27) years, p = 0.01. Otherwise, the groups did not statistically significantly differ in diabetes duration, BMI, and representation of women with type 2 diabetes. A better glycemic control (HbA1c, mmol/mol) was achieved in the Group A in all trimesters – 1st trimester: 59 (47, 67) vs 66 (56, 76), 2nd trimester: 46 (40, 52) vs 54 (48, 59) and 3rd trimester: 46 (40, 51) vs 53 (47, 60), p = 0.01. The caesarean section rate decreased (65.2 % vs 87.5 %, p < 0.05). The incidence of the respiratory distress syndrome after adjustment for age and diabetes duration also decreased (8.9 % vs 18.2 %, p < 0.05). A decreasing trend in the rate of premature delivery before 34th week of gestation (1.1 % vs 6.3 %) and neonatal mortality (1.1 % vs 2.9 %) was observed, however, the differences were not statistically significant.

Conclusion:
The achieved improved glycemic control led to only a partial improvement in the course of pregnancy and outcome of the offspring of diabetic mothers.

Key words:
offspring of diabetic mother – pregestational diabetes – pregnancy – type 1 and type 2 diabetes mellitus


Sources

1. Evers IM, de Valk HW, Visser GHA. Risk of complications of pregnancy in women with type 1 diabetes: nationwide prospective study in the Netherlands. BMJ 2004; 28(7445):915. Dostupné z DOI: <http://dx.doi.org/10.1136/bmj.38043.583160.EE>.

2. Clausen TD, Mathiesen E, Ekbom P et al. Poor pregnancy outcome in women with type 2 diabetes. Diabetes Care 2005; 28(2): 323–328.

3. Jensen DM, Korsholm L, Ovesen P et al. Peri-conceptional A1c and risk of serious adverse pregnancy outcome in 933 women with type 1 diabetes. Diabetes Care 2009; 32(6): 1046–1048.

4. Dunne F, Brydon P, Smith K et al. Pregnancy in women with type 2 diabetes: 12 years outcome data 1990–2002. Diabet Med 2003; 20(9): 734–738.

5. Teramo KA. Obstetric problems in diabetic pregnancy – The role of fetal hypoxia. Best Pract Res Clin Endocrinol Metab 2010; 24(4): 663–671.

6. Mathiesen ER, Kinsley B, Amiel SA et al. Insulin Aspart Pregnancy Study Group. Maternal glycemic control and hypoglycemia in type 1 diabetic pregnancy: a randomized trial of insulin aspart versus human insulin in 322 pregnant women. Diabetes Care 2007; 30(4): 771–776.

7. Mathiesen ER, Hod M, Ivanisevic M et al. Maternal efficacy and safety outcomes in a randomized, controlled trial comparing insulin detemir with NPH insulin in 310 pregnant women with type 1 diabetes. Diabetes Care 2012; 35(10): 2012–2017.

8. Cyganek K, Hebda-Szydlo A, Katra B et al. Glycemic control and selected pregnancy outcomes in type 1 diabetes women on continuous subcutaneous insulin infusion and multiple daily injections: the significance of pregnancy planning. Diabetes Technol Ther 2010; 12(1): 41–47.

9. Temple RC, Aldbridge VJ, Murphy HR. Prepregnancy care and pregnancy outcome in women with type 1 diabetes. Diabetes Care 2006; 29(8): 1744–1749.

10. Klemetti M, Nuutila M, Tikkanen M et al. Trends in maternal BMI, glycaemic control and perinatal outcome among type 1 diabetic pregnant women in 1989–2008. Diabetologia 2012; 55(9): 2327–2334.

11. Murphy HR, Steel SA, Roland JM et al. East Anglia Study group for improving pregnancy outcomes in women with diabetes (EASIPOD). Obstetric and perinatal outcomes in pregnancies complicated by Type 1 and Type 2 diabetes: influences of glycaemic control, obesity and social disadvantage. Diabet Med 2011; 28(9): 1060–1067.

12. Murphy HR, Rayman G, Duffield K et al. Changes in the glycemic profile of women with type 1 and type 2 diabetes during pregnancy. Diabetes Care 2007; 30(11): 2785–2791.

13. Kimmerle R, Zaβ RP, Cupisti S et al. Pregnancies in women with diabetic nephropathy: long-term outcome for mother and child. Diabetologia 1995; 38(2): 227–235.

14. Imbasciati E, Gregorini G, Cabiddu G et al. Pregnancy in CKD stages 3 to 5: fetal and maternal outcomes. Am J Kidney Dis 2007; 49(6): 753–762.

15. Laopaiboon M, Lumbiganon P, Intarut N et al. WHO Multicountry Survey on Maternal Newborn Health Research Network. Advanced maternal age and pregnancy outcomes: a multicountry assessment. BJOG 2014; 121(Suppl 1): 49–56.

16. Carolan MC, Davey MA, Biro M et al. Very advanced maternal age and morbidity in Victoria, Australia: a population based study. BMC Pregnancy Childbirth 2013; 13: 80. Dostupné z DOI: <http://dx.doi.org/10.1186/1471–2393–13–80>.

17. Beyerlein A, von Kries R, Hummel M et al. Improvement in pregnancy-related outcomes in the offspring of diabetic mothers in Bavaria, Germany, during 1987–2007. Diabet Med 2010; 27(12): 1379–1384.

18. Bell R, Bailey K, Cresswell T et al. Northern Diabetic Pregnancy Survey Steering Group. Trends in prevalence and outcomes of pregnancy in women with pre-existing type I and II diabetes. BJOG 2008; 115(4): 445–452.

Labels
Diabetology Endocrinology Internal medicine

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