Pregnancy loss and neonatal death in women with type 1 or type 2 diabetes mellitus |
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| Affiliation: | 1. Department of Medicine (Canadian Center for Health and Safety in Agriculture), University of Saskatchewan, Saskatoon, Saskatchewan, Canada;2. Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada;3. Ministry of Health, Government of Saskatchewan, Regina, Saskatchewan, Canada;4. Department of Computer Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada;1. Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia;2. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia;1. National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy;2. Laboratory of Healthcare Research and Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy;3. Obstetrics and Gynecology Unit, School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy;4. Epidemiologic Observatory, Lombardy Regional Health Service, Milan, Italy;5. PENTA Foundation, Padua, Italy;6. Department of Internal Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy;7. Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy;1. Research Centre for Natural Sciences, Institute of Technical Physics and Materials Science (MFA), Konkoly-Thege M. út 29-33, H-1121 Budapest, Hungary;2. Department of Electrical and Computer Engineering, Virginia Commonwealth University, 601W Main St, Richmond, VA 23284, USA;3. Department of Physics, Virginia Commonwealth University, 701W. Grace St., Richmond, VA 23284, USA;4. Wigner Research Centre for Physics, Institute for Particle and Nuclear Physics, Konkoly-Thege M. út 29-33, H-1121 Budapest, Hungary;1. Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark;2. Center for Pregnant Women with Diabetes, Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark;3. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark;4. Steno Diabetes Center, Gentofte, Denmark;1. Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark;2. Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark;3. Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark;4. Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark;5. Steno Diabetes Center Copenhagen, Gentofte, Denmark;6. Mater Clinical School and Mater Research, The University of Queensland, Brisbane, Australia |
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| Abstract: | Background: Diabetes mellitus (DM) is known to be a significant risk factor for pregnancy loss, either through still-birth or late intrauterine death or as the result of severe congenital malformation. Improved glycemic control and other advances in care substantially reduced the incidence of pregnancy loss in women with type 1 DM in most countries by the 1970s. However, because of a greater prevalence of obesity since the 1980s, the emergence of type 2 DM in pregnancy has become a significant problem. Although more pregnancies now occur in women with type 2 DM than in those with type 1 DM in many locations, relatively little information has been published about pregnancy loss in type 2 DM.Objectives: This article examines the prevalence and causes of pregnancy loss in type 1 and type 2 DM and identifies factors in addition to glycemic control that may influence pregnancy outcome.Methods: A MEDLINE search was conducted for recent literature on pregnancy loss in DM. Series reporting >200 pregnancies in type 1 DM and/or >100 pregnancies in type 2 DM were included.Results: Thirty-four studies were identified (15 in type 1 DM [1997-2007], 19 in type 2 DM [1986-2007]). In type 1 DM, major congenital anomalies now account for ~50% of pregnancy losses, and all-cause perinatal mortality remains higher than in the general population. Several studies have suggested that the perinatal mortality rate is higher in type 2 DM than in type 1 DM. Factors other than glycemic control probably explain this phenomenon: women with type 2 DM typically are older and more obese, and they come from disadvantaged communities—all risk factors for pregnancy loss, particularly late intrauterine death and chorioamnionitis. In some women, type 2 DM may be recognized for the first time during pregnancy; pregnancies in these women carry the same risks of pregnancy loss as those in women with established DM.Conclusions: Demographic changes in the prevalence of obesity suggest that the prevalence of type 2 DM in pregnancy will almost certainly increase. Although meticulous glycemic control is undoubtedly important in achieving good pregnancy outcomes, clinicians should be aware of the multiple risk factors faced by women with DM. |
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