Obstetric and perinatal outcomes in type 1 diabetic pregnancies – a large, population-based study

  1. Martina Persson, M.D (Martinap{at}bredband.net)1,
  2. Mikael Norman, M.D Prof.1 and
  3. Ulf Hanson, M.D Assoc. Prof.2
  1. 1Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm and
  2. 2Department of Woman and Child Health, Uppsala University, Sweden

    Abstract

    Objective: to perform comparative analyses of obstetric and perinatal outcomes between type 1 diabetic pregnancies (T1DM) and the general obstetric population in Sweden between 1991 and 2003.

    Research design and Methods: Population based study. Data were obtained from the Medical Birth Registry, covering more than 98% of all pregnancies in Sweden. A total of 5,089 T1DM pregnancies and 1,260,207 controls were included. Odds ratios (OR) were adjusted for group differences in maternal age, parity, BMI, chronic hypertensive disease, smoking habits and ethnicity.

    Results: In T1DM, preeclampsia was significantly more frequent [OR=4.47 (3.77–5.31)] as well as delivery with Cesarean section [OR=5.31 (4.97–5.69)] compared to the general population. Stillbirth [OR=3.34 (2.46-4.55)], perinatal mortality [OR=3.29 (2.50-4.33)] and major malformations [OR=2.50 (2.13-2.94)] were more common in T1DM than in controls. Risk of very preterm birth (<32 gestational weeks) was also higher among T1DM women [OR=3.08 (2.45–3.87)]. The incidence of fetal macrosomia (birth weight 2 SD or more above the mean) was much increased in the diabetes group [OR=11.45 (10.61–12.36)].

    Conclusion: T1DM in pregnancy is still associated with considerably increased rates of adverse obstetric and perinatal outcomes. The 8-fold increased risk for fetal macrosomia in T1DM pregnancies is unexpected and warrants further investigation.

    Footnotes

      • Received April 4, 2009.
      • Accepted August 3, 2009.

    This Article

    1. Diabetes Care
    1. All Versions of this Article:
      1. dc09-0656v1
      2. 32/11/2005 most recent