Impact of type 2 diabetes, obesity and glycaemic control on pregnancy outcomes.
BACKGROUND
There are no contemporary cohorts examining pregnancy outcomes in women with type 2 diabetes (T2D) in Australia.


OBJECTIVE
To compare pregnancy outcomes in women with and without T2D, and assess effects of body mass index (BMI) and glycaemic control on outcomes.


METHODS
An historical cohort study was conducted of all singleton births > 20 weeks gestation at a specialist maternity network in Australia from 2010 to 2013. Data were extracted from the Birthing Outcomes System database. Multivariable logistic regression analysis was used to examine associations between presence of T2D and pregnancy outcomes.


RESULTS
Outcomes for 138 pregnancies with T2D and 27 075 pregnancies in women without diabetes were compared (type 1 diabetes and gestational diabetes excluded). Women with T2D were older and more overweight compared to women without diabetes (P < 0.01). Their babies were born earlier (P < 0.01) with increased risk of large for gestational age (adjusted odds ratio 2.13 (95% CI 1.37-3.32)), hypoglycaemia (4.90 (2.79-8.61)), jaundice (2.58 (1.61-4.13)) and shoulder dystocia (2.72 (1.09-6.78)), but not congenital malformations or perinatal death. Women with T2D had a higher risk of induction (4.03 (2.71-5.99)), caesarean section (2.10 (1.44-3.04)), preterm birth (2.74 (1.78-4.24)) and pre-eclampsia (2.75 (1.49-5.10)). An HbA1c ≥ 6.0% (42 mmol/mol) was associated with increased preterm birth, special care nursery admission, hypoglycaemia and jaundice.


CONCLUSIONS
Despite availability of preconception care, good glycaemic control and specialist management, T2D remains associated with increased adverse obstetric and neonatal outcomes. Further research to examine predictors of adverse outcomes may assist in targeted antenatal surveillance and management.
Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.|Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria, Australia.
Sally K
SK
Abell
Refugee and Indigenous Women's Health, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.|Monash Women's Services, Monash Health, Melbourne, Victoria, Australia.
Jacqueline A
JA
Boyle
Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria, Australia.|Chronic Disease Prevention, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Barbora
B
de Courten
Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.|Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria, Australia.
Georgia
G
Soldatos
Monash Women's Maternity Services, Monash Health, Melbourne, Victoria, Australia.|Department of Obstetrics and Gynaecology, Ritchie Centre, Monash University, Melbourne, Victoria, Australia.
Euan M
EM
Wallace
Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria, Australia.|Diabetes, Vascular Health and Ageing, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Sophia
S
Zoungas
Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.|Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria, Australia.
Helena J
HJ
Teede
D000328:Adult; D001315:Australia / Q000453:epidemiology; D015992:Body Mass Index; D016022:Case-Control Studies; D002585:Cesarean Section / Q000706:statistics & numerical data; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000453:epidemiology*; D004420:Dystocia / Q000453:epidemiology*; D005260:Female; D005320:Fetal Macrosomia / Q000453:epidemiology*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology*; D015931:Intensive Care, Neonatal / Q000706:statistics & numerical data; D007567:Jaundice, Neonatal / Q000453:epidemiology*; D007751:Labor, Induced / Q000706:statistics & numerical data; D008297:Male; D009765:Obesity / Q000453:epidemiology; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology; D055815:Young Adult
D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
glycaemic control; obesity; pregnancy outcome; type 2 diabetes