Perinatal outcomes in pregnancies complicated by type 1 diabetes mellitus

Abstract

The aim of this study was to explore the risk of perinatal outcomes in pre-gestational type 1 diabetes mellitus (T1DM) compared to gestational diabetes mellitus (GDM) and pregnancy without diabetes and to examine the association of glycemic level of third-trimester gestation with perinatal outcomes in T1DM. We included 69 pre-gestational T1DM, 1398 cases of GDM, and 1304 control pregnancies and collected data regarding demographics, obstetric, and perinatal outcomes from the hospital discharge database. Relative to the pregnancies without diabetes, women with T1DM encountered increasing risk of polyhydramnios, preterm delivery, and cesarean section. These adverse outcomes were also common in GDM, although with relatively lower adjusted ORs. The weights of babies delivered by women with T1DM were more intend to be large for gestational age, as well as to be less than 2.5 kg relative to those without diabetes. Poorly controlled hemoglobin A1c in late pregnancy was significantly associated with an increased risk of preterm birth in T1DM (adjusted odds ratio 2.01, 95%confidence interval 1.1–3.6). Women with T1DM have considerably increased risks of adverse perinatal outcomes, which appear more prevalent than the perinatal outcomes in women with GDM. Thus, a specific routine is required for pregnancy in T1DM to improve the glycemic control and obstetric care.

Chinese abstract

本研究的目的是探讨妊娠期1型糖尿病(T1DM)与妊娠期糖尿病(GDM)和非糖尿病妊娠对围产期结局的影响, 以及妊娠晚期血糖水平与T1DM围产期结局的关系。我们纳入69例孕前T1DM, 1398例妊娠期糖尿病和1304例对照妊娠女性, 并从医院出院数据库中收集有关人口学、产科和围产期结局的数据。与非糖尿病孕妇相比, 患1型糖尿病的孕妇羊水过多、早产和剖宫产的风险增加。这些不良结局在妊娠期糖尿病中也很常见, 尽管调整后的OR值相对较低。与没有糖尿病的产妇相比, 患1型糖尿病的女性产下的新生儿更倾向于大于胎龄儿, 和小于2.5kg。妊娠晚期糖化血红蛋白A1c控制不良与T1DM早产风险增加显著相关(调整后优势比2.01, 95%可信区间1.1-3.6)。患有1型糖尿病的妇女发生不良围产期结局的风险显著增加, 似乎比妊娠期糖尿病妇女的围产期结局更为普遍。因此, 需要对T1DM孕妇进行特殊的规范治疗, 以改善血糖控制和产科护理。

Keywords:

• Type 1 diabetes mellitus
• gestational diabetes mellitus
• perinatal outcomes
• HbA1c

Ethics approval and consent to participate

This study was conducted with the approval of the Institutional Ethics Committee of Drum Tower Hospital, Nanjing University Medical School to collect the clinical data with informed consent. The study was performed in accordance with the Declaration of Helsinki.

Author contributions

JL, YB, and DLZ designed the study. QYX and JL conducted the study, performed the analysis, and wrote the manuscript. JH and JJL contributed to the conduct of the study. ZJG was in charge of statistical analysis and revised the manuscript. YB and DLZ supervised the study and critically reviewed the manuscript for important intellectual content. All authors contributed to the interpretation of data, revision of the manuscript, and provided final approval of the version to be published.

Disclosure statement

The authors report no conflicts of interest.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author (Yan Bi, e-mail: [email protected]) on reasonable request.

Additional information

Funding

This work was supported by the National Natural Science Foundation of China Grant Award [grant number 81570737], [grant number 81570736], [grant number 81500612], [grant number 81600632], [grant number 81600637] and the National Key Research and Development Program of China [grant number 2017YFC1309605].