Improvement in pregnancy-related outcomes in the offspring of diabetic mothers in Bavaria, Germany, during 1987-2007.
OBJECTIVE
Reducing the risk of adverse outcomes in diabetic pregnancies to the level of risk in non-diabetic pregnancies is a major goal in diabetes care. So far there have not been any data to show whether progress is being made towards this goal.


METHODS
We used population-based data on 2,292,053 deliveries between 1987 and 2007 in Bavaria, Germany, to assess temporal trends for stillbirths, early neonatal mortality, preterm delivery, macrosomia and malformations in consecutive 7 year intervals. We estimated prevalences and prevalence odds ratios for these outcomes. For stillbirth, as the most severe adverse outcome, we assessed the contributions of several predictors using multiple regression models.


RESULTS
With the exception of early neonatal deaths, the risks for all outcomes were significantly increased in the offspring of mothers with pregestational diabetes in all three time periods (e.g. odds ratio for stillbirths in diabetic compared with non-diabetic mothers in 2001-2007, 1.89; 95% confidence interval 1.24, 2.87). However, the prevalence of stillbirths, premature delivery and macrosomia decreased over time in diabetic mothers (e.g. 1.71% for stillbirths in 1987-1993 and 0.66% in 2001-2007), as did the respective odds ratios. Maternal smoking, hypertension and substandard utilization of antenatal care were significantly associated with stillbirths in diabetic women.


CONCLUSIONS
Although the risk of adverse pregnancy outcomes is still increased in diabetic mothers, considerable improvement has been achieved. We hypothesize that this improvement is possibly due to improved diabetes care.
Division of Epidemiology, Institute of Social Paediatrics and Adolescent Medicine, Ludwig-Maximilians University of Munich, Germany. andreas.beyerlein@med.uni-muenchen.de
A
A
Beyerlein
R
R
von Kries
M
M
Hummel
N
N
Lack
B
B
Schiessl
G
G
Giani
A
A
Icks
D000293:Adolescent; D000328:Adult; D000013:Congenital Abnormalities / Q000453:epidemiology* / Q000517:prevention & control; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D005260:Female; D005320:Fetal Macrosomia / Q000453:epidemiology / Q000517:prevention & control; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D016017:Odds Ratio; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D011254:Pregnancy in Diabetics; D018566:Pregnancy, High-Risk; D015995:Prevalence; D012307:Risk Factors; D055815:Young Adult