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Published online June 22, 2007
Diabetes Care 30:2603-2607, 2007
DOI: 10.2337/dc07-0555
© 2007 by the American Diabetes Association
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Pathophysiology/Complications
Original Article

Differing Causes of Pregnancy Loss in Type 1 and Type 2 Diabetes

Tim Cundy, MD1,2, Greg Gamble, MSC1, Leonie Neale, RM2, Rose Elder, FRACOG2, Paul McPherson, FRACOG2, Patrick Henley, FRACP2 and Janet Rowan, FRACP2

1 Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
2 Diabetes Pregnancy Service, National Women's Health, Auckland City Hospital, Auckland, New Zealand

Address correspondence and reprint requests to Dr. Tim Cundy, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand. E-mail: t.cundy{at}auckland.ac.nz

OBJECTIVE—Women with type 2 and type 1 diabetes have differing risk factors for pregnancy loss. We compared the rates and causes of pregnancy loss in women with type 1 and type 2 diabetes.

RESEARCH DESIGN AND METHODS—We utilized prospectively collected data on all pregnancies in a 20-year period (1986–2005) from a single center with a high prevalence of type 2 diabetes. Pregnancy losses included terminations for medical reasons and deaths up to 1 month postpartum but not spontaneous pregnancy losses <20 weeks’ gestation.

RESULTS—There were 870 pregnancies in women with known diabetes (330 with type 1 and 540 with type 2 diabetes) and 325 in women with diabetes diagnosed in pregnancy but persisting postpartum (97% type 2 diabetes). The rate of pregnancy loss was similar in type 1 and type 2 diabetes (2.6 vs. 3.7%, P = 0.39), but the causes of pregnancy loss differed. In type 1 diabetes >75% were attributable to major congenital anomalies or prematurity; in type 2 diabetes >75% were attributable to stillbirth or chorioamnionitis (P = 0.017). Women with type 2 and type 1 diabetes had similar A1C at presentation and near term, but the former were older (P < 0.001) and more obese (P < 0.0001).

CONCLUSIONS—There are significant differences in the main causes of pregnancy loss in women with type 1 and type 2 diabetes. The higher rates of stillbirth in women with type 2 diabetes, suggest that other features, such as obesity, contribute significantly to pregnancy losses.


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