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Outcomes in Type 1 Diabetic Pregnancies

A nationwide, population-based study

¹ Department of Endocrinology, Odense University Hospital, Odense, Denmark
² Obstetric Clinic, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
³ Department of Obstetrics and Gynaecology, Copenhagen County Hospital, Glostrup, University of Copenhagen, Copenhagen, Denmark
⁴ Department of Obstetrics and Gynaecology, Aarhus University Hospital, Skejby Sygehus, Aarhus, Denmark
⁵ Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark
⁶ Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark

Address correspondence and reprint requests to Henning Beck-Nielsen and Dorte M. Jensen, Department of Endocrinology, Odense University Hospital, Kløvervænget 6 DK-5000, Odense, Denmark. E-mail: dortemj{at}dadlnet.dk

OBJECTIVE—The aim of this study was to compare pregnancy outcomes in type 1 diabetic pregnancies with the background population.

RESEARCH DESIGN AND METHODS—This nationwide prospective multicenter study took place in eight Danish centers treating pregnant women with type 1 diabetes during 1993–1999. A total of 990 women with 1,218 pregnancies and delivery after 24 weeks (n = 1,215) or early termination due to severe congenital malformations (n = 3) were included. Data were collected prospectively by one to three caregivers in each center and reported to a central registry.

RESULTS—The perinatal mortality rate was 3.1% in type 1 diabetic pregnancies compared with 0.75% in the background population (RR 4.1 [95% CI 2.9–5.6]), and the stillbirth rate was 2.1% compared with 0.45 (4.7 [3.2–7.0]). The congenital malformation rate was 5.0% in the study population and 2.8% (1.7 [1.3–2.2]) in the background population. Six of the perinatal deaths (16%) were related to congenital malformations. Only 34% of women performed daily home monitoring of blood glucose at conception, and 58% received preconceptional guidance. Pregnancies with serious adverse outcomes (perinatal death and/or congenital malformations) were characterized by higher HbA_1c values before and during pregnancy and a lesser degree of maternal self-care and preconceptional guidance. Women who performed daily self-monitoring of blood glucose at any time during pregnancy had lower HbA_1c values than women who did not measure their daily profile. Likewise, daily self-monitoring was associated with a reduction in serious adverse outcomes. The caesarean section rate was 55.9 and 12.6%, respectively, and the risk of preterm delivery was 41.7 and 6.0%, respectively.

CONCLUSIONS—Type 1 diabetic pregnancies are still complicated by considerably higher rates of severe perinatal complications compared with the background population, and women with poor self-care are at the highest risk. Adequate glycemic control using daily glucose monitoring before and during pregnancy is a crucial step toward reaching the goals of the St. Vincent declaration.

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