Prevalence of adverse pregnancy outcomes in women with pre-gestational diabetes at a multidisciplinary clinic — ASN Events
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  3. Prevalence of adverse pregnancy outcomes in women with pre-gestational diabetes at a multidisciplinary clinic

Prevalence of adverse pregnancy outcomes in women with pre-gestational diabetes at a multidisciplinary clinic (#7)

Jenny Wright 1 , Tang Wong 1 2 3 , Stephanie Terry 1 , Robyn Barnes 1 2 , Jeff Flack 1 3 4
  1. Bankstown-Lidcombe Hospital, Sydney, NSW, Australia
  2. School of Medicine, Western Sydney University, Sydney, Sydney, NSW, Australia
  3. Faculty of Medicine, University of New South Wales, Sydney , Sydney, NSW, Australia
  4. School of Medicine, Western Sydney University, Sydney, Sydney, NSW, Australia

Background

Pregnant women with type 1 diabetes(T1D) or type 2 diabetes(T2D) require intensive multidisciplinary management to optimise maternal and neonatal outcomes.

This study investigated the characteristics and clinical outcomes of pregnant women with pre-gestational diabetes who receiving intensive management throughout pregnancy in a tertiary hospital outpatient clinic/service.

METHODS:

A retrospective analysis of consecutive women with pre-gestational diabetes(May 2018-April 2023). Variables collected included maternal age, ethnicity, gravida/parity, gestational age and HbA1c at 1st visit, BMI, gestational weight gain(GWG) and maximal total daily insulin dose. Outcomes assessed included miscarriage/stillbirth, rates of caesarean section, pre-term labour(<37weeks), large for gestational age (LGA >90th percentile) and small for gestational age(SGA <10th percentile) in T1D vs T2D.

Independent samples t-test and Chi-square analyses were used for continuous and categorical variables, respectively(SPSS-ver24). P-value <0.05 defined significance.

RESULTS:

A total of 99 women including 25(25.3%) with T1D and 74(74.7%) with T2D. As Table 1 shows women with T1D were younger, had lower pre-gestational BMI, but had higher GWG compared to women with T2D. There were fewer South-Asian women with T1D(4.0% vs 30.6%, p<0.01) vs T2D, but no significant differences in Caucasian, Middle-Eastern, South-East Asian and Pacific Islander women.

There were no significant differences in gravida(3.0±1.7 vs 3.7±2.7), parity(1.1±1.1 vs 1.6±1.6), gestational age (12.2 vs 15.5 weeks) or HbA1c(7.4%±1.4 vs 6.9%±1.7) at 1st visit in T1D vs T2D. Similarly, there were no significant differences in delivery methods: caesarean section(52.0% vs 52.7%), forceps/suction(5.3% vs 4.6%) and induction of labour(42.1% vs 44.6%) in T1D vs T2D.

T1D women required significantly less insulin compared to T2D with maximum total daily insulin dose(72.0±36.8 vs 111.9±86.8units, p<0.05). T1D was associated with higher rates of premature delivery(58.3% vs 32.4%, OR0.34, 95%CI0.13-0.88), LGA infants(52% vs 21.6%, OR 0.26, 95%CI0.10-0.67) and higher crude birthweight(3629.3±737.4 vs 3162.8±744.9grams, <0.05) in women with T1D compared to T2D.   

No significant differences in rates of stillbirth(4.0% vs 1.4%), miscarriage(20.0% vs 10.8%), shoulder dystocia(5.3% vs 3.1%), SGA(4.0% vs 9.5%), neonatal hypoglycaemia(52.9% vs 30.8%), neonatal jaundice(35.5% vs 20.3%) and breastfeeding(85.7% vs 78.7%) in T1D vs T2D were noted.

CONCLUSION:

Women with T1D and T2D frequently present late and have suboptimal glycaemic control on presentation. Overall rates of adverse pregnancy outcomes are high in women with pre-gestational diabetes. There were high rates of pre-term delivery and LGA, in T1D versus T2D women, despite both receiving intensive management. These findings reinforce the importance of intensive pre-pregnancy and pregnancy management of patients with pre-existing diabetes.

 

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