Factors Associated With Preterm Delivery in Women With Type 1 Diabetes
A cohort study
- Jacques Lepercq, MD1,
- Joel Coste, MD2,
- Anne Theau, MD2,
- Daniele Dubois-Laforgue, MD3 and
- Jose Timsit, MD3
- 1Department of Obstetrics and Gynecology, Hospital Cochin, Saint Vincent de Paul, Paris, France
- 2Department of Biostatistics, Hospital Cochin, Saint Vincent de Paul, Paris, France
- 3Department of Diabetology, Hospital Cochin, Saint Vincent de Paul, Paris, France
- Address correspondence and reprint requests to Jacques Lepercq, MD, Service de Gynecologie-Obstetrique, Hopital Cochin, Saint Vincent de Paul, AP-HP, 82, avenue Denfert-Rochereau, 75674 Paris Cedex 14, France. E-mail: j.lepercq{at}svp.ap-hop-paris.fr
Abstract
OBJECTIVE—The reported rate of preterm delivery in women with type 1 diabetes ranges from 22 to 45%, but the reasons are unclear. The purpose of this study was to identify factors associated with preterm delivery in these women.
RESEARCH DESIGN AND METHODS—We studied the influence of maternal and diabetes-related factors on the occurrence of preterm delivery in 168 single pregnancies occurring in 127 women with type 1 diabetes. Women with spontaneous or indicated preterm delivery were compared with those who delivered after 37 weeks of gestation using polytomous logistic regression.
RESULTS—The overall rate of preterm delivery was 24%, fivefold higher than the French prematurity rate in single pregnancy. Preterm delivery was spontaneous in 9% and indicated in 15%. HbA1c ≥7% at delivery was associated with spontaneous preterm delivery (odds ratio [OR] 5.3 [95% CI 1.1–26.8]). Nulliparity (12.0 [2.3–64.1]), progression of nephropathy (7.7 [1.3–46.9]), preeclampsia (12.0 [3.1–47.1]), and HbA1c ≥7% (7.5 [1.5–37.9]) at delivery were all associated with indicated preterm delivery. Preterm delivery was associated with significant neonatal morbidity as the risks for neonatal hypoglycemia and respiratory distress syndrome were increased by three- to sixfold compared with the reference group.
CONCLUSIONS—The rate of preterm delivery remains high in women with type 1 diabetes. Different factors were associated with spontaneous and indicated preterm delivery, respectively. Because poor glycemic control was a risk factor for both outcomes, part of preterm delivery might be preventable.
- LGA, large for gestational age
- NICU, neonatal intensive care unit
- RDS, respiratory distress syndrome
- SGA, small for gestational age
- UAE, urinary albumin excretion
Footnotes
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A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
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- Accepted August 27, 2004.
- Received June 16, 2004.
- DIABETES CARE
