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Am J Perinatol 2002; 19(4): 169-176
DOI: 10.1055/s-2002-28499
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Normal Perinatal Mortality in Type 1 Diabetes Mellitus in a Series of 300 Consecutive Pregnancy Outcomes

Bernice R. Wylie1, 2 , Jason Kong2, 3 , Sharon E. Kozak1 , Colleen J. Marshall1 , Suet On Tong1 , David M. Thompson1, 2
  • 1British Columbia Women's Hospital, British Columbia, Canada
  • 2University of British Columbia, British Columbia, Canada
  • 3Vancouver Hospital, British Columbia, Canada
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Publikationsdatum:
13. Mai 2002 (online)

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ABSTRACT

Reports of outcomes of pregnancy in women with type 1 diabetes have consistently found increased perinatal mortality and morbidity. The primary objective of our study was to compare the perinatal mortality rate in type 1 diabetic pregnancies with that of the general population. The secondary objective was to compare the morbidities in these groups. A series of 247 women with type 1 diabetes had 300 consecutive pregnancy outcomes analyzed over a 10-year period. They were compared with the control population from the same hospital. Perinatal mortality was 6.6/1000 (95% CI, 0-17), which was significantly lower than the control population rate of 31/1000. There was an increased incidence of morbidity including maternal hypertension, caesarian section, preterm delivery, birth injury, large for gestational age infants, admissions to neonatal intensive care, neonatal hypoglycemia, and phototherapy. Pregnancies in type 1 diabetes can be associated with a normal perinatal mortality rate although morbidity remains elevated compared with controls.

KEYWORDS

Type 1 diabetes mellitus - fetal/maternal complications - pregnancy

REFERENCES

  • 1 Mort Morb Weekly Reports. Perinatal mortality and congenital malformations in infants born to women with insulin-dependent diabetes mellitus: United States, Canada and Europe, 1940-88.  MMWR . 1990;  39 363-365
    PubMedGoogle Scholar
  • 2 Diabetes care and research in Europe: the Saint Vincent declaration. Diabet Med .  1990;  7 360
    PubMedGoogle Scholar
  • 3 Bourgeois F, Duffer J. Outpatient obstetric management of women with Type 1 diabetes.  Am J Obstet Gynecol . 1990;  163 1065-1073
    PubMedGoogle Scholar
  • 4 Kitzmiller J, Gavin L, Gin G, Jovanovic-Peterson L, Main E, Zigrang W. Preconception care of diabetes: glycemic control prevents congenital anomalies.  JAMA . 1991;  265 731-736
    CrossrefPubMedGoogle Scholar
  • 5 Multicenter survey of diabetic pregnancy in France. Gestation and Diabetes in France Study Group.  Diabetes Care . 1991;  14 994-1000
    PubMedGoogle Scholar
  • 6 Hunter D, Burrows R, Mohide P, Whyte R. Influence of maternal insulin-dependent diabetes mellitus on neonatal morbidity.  Can Med Assoc J . 1993;  149 47-51
    PubMedGoogle Scholar
  • 7 Hanson U, Persson B. Outcome of pregnancies complicated by type 1 insulin-dependent diabetes in Sweden: acute pregnancy complication, neonatal mortality and morbidity.  Am J Perinatol . 1993;  10 330-333
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 8 Cnattingius S, Berne C, Nordstrom M. Pregnancy outcome and infant mortality in diabetic women in Sweden.  Diabet Med . 1994;  11 696-700
    PubMedGoogle Scholar
  • 9 The Diabetes Control and Complications Trial Research Group. Pregnancy outcomes in the Diabetes Control and Complications Trial.  Am J Obstet Gynecol . 1996;  17 1143-1153
    PubMedGoogle Scholar
  • 10 Casson I, Clarke C, McKendrick O. Outcomes of pregnancy in insulin dependent diabetic women: results of a five year population cohort study.  Br Med J . 1997;  315 275-278
    PubMedGoogle Scholar
  • 11 Hawthorne G, Robson S, Ryall E, Roberts S, Platt M. Prospective population based survey of outcome of pregnancy in diabetic women: results of the Northern Diabetic Pregnancy Audit.  Br Med J . 1997;  315 279-281
    PubMedGoogle Scholar
  • 12 Nielsen G, Sorensen H, Nielsen P, Sabroe S, Olsen J. Glycosylated hemoglobin as predictor of adverse fetal outcome in type 1 diabetic pregnancies.  Acta Diabetol . 1997;  34 217-222
    CrossrefPubMedGoogle Scholar
  • 13 Hadden D R. How to improve prognosis in type 1 diabetic pregnancy.  Diabetes Care . 1999;  B104-B108
    PubMedGoogle Scholar
  • 14 Lorenzen T, Pociot F, Johannesen J, Kristiansen O, Nerup J. A population based survey of frequencies of self-reported spontaneous and induced abortions in Danish women with type 1 diabetes mellitus.  Diabet Med . 1999;  16 472-476
    CrossrefPubMedGoogle Scholar
  • 15 Brown S, Kyne-Grzebalski D, Mwangi B, Taylor R. Effect of management policy upon 120 type 1 diabetic pregnancies: policy decisions in practice.  Diabet Med . 1999;  16 573-578
    CrossrefPubMedGoogle Scholar
  • 16 Vaarasmaki M, Hartikainen A-L, Anttila M, Pirttiaho H. Out-patient management does not impair outcome of pregnancy in women with type 1 diabetes.  Diabetes Res Clin Pract . 2000;  47 111-117
    CrossrefPubMedGoogle Scholar
  • 17 McElvy S, Miodovnik M, Rosenn B. A focused preconceptional and early pregnancy program in women with type 1 diabetes reduces perinatal mortality and malformation rates to general population levels.  J Matern Fetal Med . 2000;  9 14-20
    CrossrefPubMedGoogle Scholar
  • 18 Report of the Expert ComReport of the Expert Committee on the diagnosis and classification of diabetes mellitus. Diabetes Care .  1997;  29 1183-1197
    PubMedGoogle Scholar
  • 19 White P. Classification of obstetric diabetes.  Am J Obstet Gynecol . 1978;  130 228-230
    PubMedGoogle Scholar
  • 20 Arbuckle T E, Wilkins R, Sherman G. Birth weight percentiles by gestational age in Canada.  Obstet Gynecol . 1993;  81 39-48
    PubMedGoogle Scholar
  • 21 Chiswick M L. Commentary on current World Health Organization definitions used in perinatal statistics.  Br J Obstet Gynecol . 1986;  93 1236-1238
    PubMedGoogle Scholar
  • 22 Karlsson K, Kjellmer L. The outcome of diabetic pregnancies in relation to the mother's blood sugar level.  Am J Obstet Gynecol . 1972;  112 213-220
    PubMedGoogle Scholar
  • 23 Langer O, Conway D. Level of glycemia perinatal outcome in pregestational diabetes.  J Matern Fetal Med . 2000;  9 35-41
    CrossrefPubMedGoogle Scholar
  • 24 Rosenn B, Miodovnik M, Combs C, Khoury J, Siddiqi T. Glycemic thresholds for spontaneous abortion congenital malformations in insulin-dependent diabetes mellitus.  Obstet Gynecol . 1994;  84 515-520
    PubMedGoogle Scholar
  • 25 Hanson U, Persson B, Thunell S. Relationship between hemoglobin A1c in early type 1 (insulin-dependent) diabetic pregnancy the occurrence of spontaneous abortion fetal malformation in Sweden.  Diabetologia . 1990;  33 100-104
    CrossrefPubMedGoogle Scholar
  • 26 Mills J. Incidence of spontaneous abortion among normal women insulin dependent diabetic women whose pregnancies were identified within 21 days of conception.  New Engl J Med . 1988;  319 1617-1623
    CrossrefPubMedGoogle Scholar
  • 27 Garner P, D'Alton M, Dudley D, Huard P, Hardie M. Preeclampsia in diabetic pregnancies.  Am J Obstet Gynecol . 1990;  163 505-508
    PubMedGoogle Scholar
  • 28 Siddiqi T, Rosenn B, Mimouni F, Khoury J, Miodovnik M. Hypertension during pregnancy in insulin-dependent diabetic women.  Obstet Gynecol . 1991;  77 514-519
    PubMedGoogle Scholar
  • 29 Greene M, Hare J, Krache M. Prematurity among insulin-requiring diabetic gravid women.  Am J Obstet Gynecol . 1989;  161 106-111
    PubMedGoogle Scholar
  • 30 Kitzmiller J, Buchanan T, Kjos S, Combs A, Ratner R. Preconception care of diabetes congenital malformations spontaneous abortions.  Diabetes Care . 1996;  19 514-541
    PubMedGoogle Scholar
  • 31 Hadden D, McCance D. Advances in management of type 1 diabetes pregnancy.  Curr Opin Obstet Gynecol . 1999;  11 557-562
    CrossrefPubMedGoogle Scholar
  • 32 Combs C, Gunderson E, Kitzmiller J, Gavin L, Main E. Relationship of fetal macrosomia to maternal postprandial glucose control during pregnancy.  Diabetes Care . 1992;  15 1251-1257
    CrossrefPubMedGoogle Scholar
  • 33 Schwartz R, Teramo K. What is the significance of macrosomia?.  Diabetes Care . 1992;  15 1201-1205
    PubMedGoogle Scholar
  • 34 Mimouni F, Miodovnik M, Rosenn B, Khoury J, Siddiqi T. Birth trauma in insulin-dependent diabetic pregnancies.  Am J Perinatol . 1992;  9 205-208
    PubMedGoogle Scholar
  • 35 Nesbitt T S, Gilbert W M, Herrchen B. Shoulder dystocia associated risk factors with macrosomic infants born in California.  Am J Obstet Gynecol . 1998;  179 476-480
    CrossrefPubMedGoogle Scholar
  • 36 Piper J, Langer O. Does maternal diabetes delay fetal pulmonary maturity?.  Am J Obstet Gynecol . 1993;  168 783-786
    PubMedGoogle Scholar
  • 37 Schwartz R. Neonatal hypoglycemia: back to basics in diagnosis treatment.  Diabetes . 1991;  71-73
    PubMedGoogle Scholar
  • 38 Stenninger E, Schollin J, Aman J. Early postnatal hypoglycemia in newborn infants of diabetic mothers.  Acta Pediatr . 1997;  86 1374-1376
    PubMedGoogle Scholar
  • 39 Demarini S, Mimouni F, Tsang R, Khoury J, Hertzberg V. Impact of metabolic control of diabetes during pregnancy on neonatal hypocalcemia: a randomized study.  Obstet Gynecol . 1994;  83 918-922
    PubMedGoogle Scholar
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