Outcomes in Type 1 Diabetic Pregnancies: A nationwide, population-based study

Epidemiology/Health Services/Psychosocial Research

Outcomes in Type 1 Diabetic Pregnancies

¹Department of Endocrinology, Odense University Hospital, Odense, Denmark
²Obstetric Clinic, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
³Department of Obstetrics and Gynaecology, Copenhagen County Hospital, Glostrup, University of Copenhagen, Copenhagen, Denmark
⁴Department of Obstetrics and Gynaecology, Aarhus University Hospital, Skejby Sygehus, Aarhus, Denmark
⁵Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark
⁶Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark

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

Diabetes Care 2004 Dec; 27(12): 2819-2823. https://doi.org/10.2337/diacare.27.12.2819

Table 1—

Obstetric complications and fetal characteristics for type 1 diabetic pregnancies and the background population

	Type 1 diabetic pregnancy	Background population	RR (95% CI) or P
n	1,215	70,089
Pre-eclampsia*	220 (18.1%)	*	<0.001
Caesarean section	680 (55.9%)	8,831 (12.6%)	4.4 (4.1–4.8)
Preterm delivery†	507 (41.7%)	4,205 (6.0%)	7.0 (6.3–7.6)
Gestational age at delivery (days)	256 ± 16	280	<0.0001
Birth weight (g)	3,487 ± 817	3,478	0.71
Birth weight ≥4,500 g	97 (8.0%)	2,383 (3.4%)	2.3 (1.9–2.9)
Large for gestational age infant‡	761 (62.5%)	—	<0.001
Stillbirth	26 (2.1%)	318 (0.45%)	4.7 (3.2–7.0)
Perinatal mortality	38 (3.1%)	525 (0.75%)	4.1 (2.9–5.6)
Congenital malformations	61 (5.0%)	1,987 (2.8%)	1.7 (1.3–2.2)
Respiratory distress syndrome§	202 (17.1%)	ND	—
Jaundice‖	215 (18.1%)	ND	—

Data are means ± SD or n (%).
*
↵* Blood pressure ≥140/90 mmHg and proteinuria. The frequency in the background population is 2.6% (other data source, see text);
†
↵† before 37 completed weeks of gestation;
‡
↵‡ birth weight ≥90th centile. The expected frequency in the background population is 10%, but exact numbers are not available;
§
↵§ use of continuous positive airway pressure for >1 h postpartum;
‖
↵‖ use of phototherapy. ND, no data.

Table 2—

Maternal characteristics in pregnancies with serious adverse outcomes (perinatal death and/or congenital malformations) versus other pregnancies

	Serious adverse outcome	Others	P
n	93	1,125
Age (years)	28 (25–31)	29 (26–32)	0.49
Preconceptional BMI (kg/m²)	22.1 (19.4–24.2)	23.0 (21.4–25.3)	0.01
Diabetes duration (years)	12 (6–18)	12 (5–19)	0.75
Daily blood glucose monitoring at conception	18 (22.5%)	363 (34.6%)	0.019
Preconceptional guidance	38 (42.7%)	631 (59.2%)	0.002
HbA_1c 0–3 months prior to conception (%)	8.0 (7.3–9.1)	7.6 (6.8–8.5)	0.005
HbA_1c during first trimester (%)	7.6 (6.6–8.6)	7.3 (6.6–8.1)	0.037
HbA_1c during second trimester (%)	6.9 (6.2–8.0)	6.6 (6.0–7.3)	0.012
HbA_1c during third trimester (%)	7.1 (6.5–7.9)	6.7 (6.2–7.4)	<0.001
Retinopathy*	5 (5.8%)	78 (7.3%)	0.58
Nephropathy†	8 (9.0%)	70 (6.4%)	0.34
Hypertension‡	6 (6.7%)	53 (4.8%)	0.45
Pre-eclampsia§	15 (18.1%)	205 (18.1%)	1.0
Large for gestational age infant‖	48 (57.1%)	713 (62.9%)	0.30

Data are median (interquartile range) or n (%). For some of the variables, the total number is <1,218 due to missing values.
*
↵* Proliferative retinopathy;
†
↵† nephropathy (urine albumin excretion >300 mg/24 h or >200 μg/min);
‡
↵‡ hypertension (pharmacological treatment) before pregnancy and/or during first trimester;
§
↵§ blood pressure ≥140/90 mmHg and proteinuria;
‖
↵‖ birth weight ≥90th centile.