Outcomes in Type 1 Diabetic Pregnancies

A nationwide, population-based study

  1. Dorte M. Jensen, PHD1,
  2. Peter Damm, DMSC2,
  3. Lars Moelsted-Pedersen, DMSC3,
  4. Per Ovesen, DMSC4,
  5. Jes G. Westergaard, DMSC5,
  6. Margrethe Moeller, MD6 and
  7. Henning Beck-Nielsen, DMSC1
  1. 1Department of Endocrinology, Odense University Hospital, Odense, Denmark
  2. 2Obstetric Clinic, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
  3. 3Department of Obstetrics and Gynaecology, Copenhagen County Hospital, Glostrup, University of Copenhagen, Copenhagen, Denmark
  4. 4Department of Obstetrics and Gynaecology, Aarhus University Hospital, Skejby Sygehus, Aarhus, Denmark
  5. 5Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark
  6. 6Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
  1. 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

Abstract

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 HbA1c 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 HbA1c 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.

Footnotes

  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • Accepted August 25, 2004.
    • Received March 17, 2004.
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  1. doi: 10.2337/diacare.27.12.2819 Diabetes Care December 2004 vol. 27 no. 12 2819-2823
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