Pregnancy in women with Type 2 diabetes: 12 years outcome data 1990-2002.
OBJECTIVE
Twelve years' outcome analysis of pregnancies in women with Type 2 diabetes in a multiethnic geographically defined area.


METHODS
Information about 182 women delivered between 1990 and 2002 was ascertained from a regional computerized database. The main outcome measures were rates of miscarriage, stillbirth, neonatal/postnatal deaths, congenital malformations, birth weight, mode of delivery, and neonatal unit care as well as maternal morbidities of polyhydramnios, postpartum haemorrhage, pregnancy-induced hypertension/pre-eclampsia.


RESULTS
Among 182 singleton pregnancies, 161 (88%) resulted in a live outcome. There were 16 (8.8%) spontaneous miscarriages, two (1.2%) stillbirths, and three (1.6%) terminations. Congenital malformations occurred in 18 pregnancies (99/1000). There were two early and one late neonatal deaths and two further deaths in the postnatal period. Twenty-eight percent of infants were large for gestational age, with 15 (9.3%) greater than 4 kg. Fifty-three percent were delivered by caesarean section and 68 (37%) required admission to neonatal unit (NNU) care. Hypertension/pre-eclampsia was two times, polyhydramnios three times, and postpartum haemorrhage six times more common than in non-diabetic women.


CONCLUSIONS
Women with Type 2 diabetes have a less satisfactory pregnancy outcome compared with the general population. Infants have a two-fold greater risk of stillbirth, a 2.5-fold greater risk of a perinatal mortality, a 3.5-fold greater risk of death within the first month and a six-fold greater risk of death up to 1 year compared with regional/national figures. They have an 11 times greater risk of a congenital malformation. We need to develop better educational and screening strategies if we are to improve.
Dunne
F
F
Department of Medicine, Division of Medical Sciences, University of Birmingham and Birmingham Women's Hospital Trust, Birmingham, UK. fidelma.dunne@uhb.nhs.uk
Brydon
P
P
Smith
K
K
Gee
H
H
D000022:Abortion, Spontaneous / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D001724:Birth Weight; D000013:Congenital Abnormalities / Q000453:epidemiology; D036861:Delivery, Obstetric / Q000379:methods; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology*; D004739:England / Q000453:epidemiology; D005260:Female; D005313:Fetal Death / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007226:Infant Mortality; D007231:Infant, Newborn; D008875:Middle Aged; D006473:Postpartum Hemorrhage / Q000453:epidemiology; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology; D011256:Pregnancy Outcome; D011254:Pregnancy in Diabetics / Q000097:blood / Q000453:epidemiology*; D012189:Retrospective Studies
D006442:Glycated Hemoglobin