The role of modifiable pre-pregnancy risk factors in preventing adverse fetal outcomes among women with type 1 and type 2 diabetes.
We investigated the fetal outcomes of pregnancy in women with pre-existing diabetes in relation to pre-pregnancy risk factors using a community-based cohort of women in Tayside, Scotland. There were 211 pregnancies in 132 women with insulin-requiring type 1 and 2 diabetes between January 1993 and December 2005. Adverse fetal outcome was classified as spontaneous miscarriage, termination for medical reasons, stillbirth, neonatal death, or congenital malformation and occurred in 61 (29%) pregnancies. Mothers with poor glycemic control pre-conceptually and at booking (HbA(1c)=7.5%) had almost a three-fold increase in adverse fetal outcome compared with mothers having fair control, odds ratio (OR) 2.59 (95% CI 1.11-6.03), and 2.71 (95% CI 1.39-5.28), respectively. Mothers who were still smoking at the booking visit had a two-fold increase in adverse fetal outcome (OR 2.12, 95% CI 1.09-4.10). Further improvement in the management of diabetes and pregnancy is needed through enhanced preconception services addressing the full spectrum of modifiable risk factors.
Inkster
Melanie E
ME
Division of Community Health Sciences, University of Dundee, MacKenzie Building, Kirsty Semple Way, Dundee, DD2 4BF, UK.
Fahey
Tom P
TP
Donnan
Peter T
PT
Leese
Graham P
GP
Mires
Gary J
GJ
Murphy
Deirdre J
DJ
D000022:Abortion, Spontaneous / Q000517:prevention & control; D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D000013:Congenital Abnormalities / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1; D003924:Diabetes Mellitus, Type 2; D005260:Female; D006442:Glycated Hemoglobin; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011254:Pregnancy in Diabetics; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D050497:Stillbirth / Q000453:epidemiology; D055815:Young Adult
D006442:Glycated Hemoglobin