title: Prediabetes and perinatal mortality.
abstract: OBJECTIVE
  The association between gestational diabetes mellitus (GDM) and perinatal outcome is largely based on case series and retrospective studies that found an increased risk of perinatal mortality and stillbirth as the onset of diabetes approached. Our objective was to assess the relationship between latency to diabetes and perinatal outcome of prediabetic pregnancies in a contemporary population of women with adult-onset diabetes.
  
  
  METHODS
  A population of 403 diabetic women from two recruitment sites completed a pretested questionnaire.
  
  
  RESULTS
  Details of 1,181 pregnancy outcomes were obtained. This comprised 1,024 live births, 22 stillbirths, and 8 early neonatal deaths. Crude analysis suggested a relationship between time to diabetes (latency) < or =20 years and both perinatal death and stillbirth: odds ratio (95% CI), 2.41 (1.17-4.95) and 2.15 (0.93-4.98). Generalized additive modeling revealed a nonlinear relationship between the variables time to diabetes, and maternal age and perinatal outcome. Final logistic regression analysis was then performed for the outcomes perinatal death and stillbirth, with maternal age as a second-degree polynomial, year of birth as a continuous variable, and time to diabetes dichotomized < or =20 years to diagnosis and >20 years. This final analysis documented a significant association between time to diabetes < or =20 years and both perinatal death (4.06 [1.79-9.36]) and stillbirth (3.35 [1.25-9.05]).
  
  
  CONCLUSIONS
  There appeared to be an increased risk of perinatal death and stillbirth in pregnancies occurring in the last 20 years before the diagnosis of diabetes.
authors: Department of Obstetrics and Gynecology, University of Calgary, Alberta, Canada. stephen.wood@crha-health.ab.ca
authors: S L
authors: SL
authors: Wood
authors: R
authors: R
authors: Sauve
authors: S
authors: S
authors: Ross
authors: R
authors: R
authors: Brant
authors: E J
authors: EJ
authors: Love
mesh_terms: D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000175:diagnosis; D005260:Female; D005313:Fetal Death / Q000209:etiology; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D016015:Logistic Models; D008423:Maternal Age; D011939:Mental Recall; D008875:Middle Aged; D011236:Prediabetic State / Q000150:complications*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors