Differing Causes of Pregnancy Loss in Type 1 and Type 2 Diabetes
- Tim Cundy, MD12,
- Greg Gamble, MSC1,
- Leonie Neale, RM2,
- Rose Elder, FRACOG2,
- Paul McPherson, FRACOG2,
- Patrick Henley, FRACP2 and
- Janet Rowan, FRACP2
- 1Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- 2Diabetes 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
Abstract
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.
Footnotes
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Published ahead of print at http://care.diabetesjournals.org on 22 June 2007. DOI: 10.2337/dc07-0555.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.
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- Accepted June 15, 2007.
- Received March 20, 2007.
- DIABETES CARE
