Perinatal outcomes for mothers with type 1 and type 2 diabetes in Scotland are worse today than they were 15 years ago. More women than ever with diabetes are becoming pregnant, and they appear to be giving birth earlier and to heavier babies compared with mothers who do not have diabetes, new data from the Scottish Morbidity Record indicate.
The results were published online January 11 in Diabetologia.
“There were marked differences in pregnancy outcomes in women with diabetes compared to non-diabetic women,” lead author Sharon Mackin, MBChB, University of Glasgow, in Scotland, and colleagues write.
The data covered more than 813,921 deliveries of infants born from 1998 through 2013.
The number of pregnancies in which there were complications caused by type 1 diabetes increased by 44%; for type 2 diabetes, the complication rate increased by 90%.
Perinatal Deaths, Stillbirths Higher but Stable Among Those With Diabetes
Rates of perinatal death among infants born to mothers with type 1 diabetes were 3.1 times higher than they were for mothers without diabetes (P < .001).
For pregnancies for mothers with type 2 diabetes, perinatal infant mortality rates were 4.2 times higher than they were for nondiabetic mothers (P < .001).
Similarly, stillbirth rates among mothers with type 1 or type 2 diabetes were 4- and 5.1-fold higher, respectively, than stillbirth rates among nondiabetic mothers (P < .001), the researchers point out.
Stillbirths among Scottish mothers occurred at a mean gestational age of 33.6 weeks for women with type 1 diabetes and 34.1 weeks for those with type 2 diabetes.
Perinatal mortality and stillbirth rates remained essentially unchanged during the 15-year study period in both groups of women with diabetes, the study authors note.
In contrast, small declines in both perinatal deaths and stillbirth rates have been documented among nondiabetic women in Scotland during the same period.
Preterm Births Increased Among Women With Diabetes
Mothers with diabetes were much more likely to give birth preterm than women without diabetes.
“On average, women with type 1 diabetes and type 2 diabetes were delivered 2.6 weeks and 2 weeks earlier than women without diabetes,” say the investigators.
Specially, 35.3% of women with type 1 diabetes and 21.8% of women with type 2 diabetes had preterm deliveries, compared with only 6.1% of women without diabetes (P < .0001).
During the 15-year study period, the proportion of preterm births increased dramatically among women with both types of diabetes, from 34.1% to 42.4% for women with type 1 diabetes, and from 11.9% to 25.5% for those with type 2 diabetes (P < .005).
However, extremely preterm deliveries, at less than 32 weeks’ gestation, were uncommon
Despite the fact that women with diabetes had earlier deliveries, “the offspring of mothers with type 1 diabetes [were] born at average weights 1.33 SD above those of the non-diabetes population, and offspring of mothers with type 2 diabetes [averaged] 0.94 SD above the non-diabetic population,” Dr Mackin and colleagues state.
Moreover, slightly more than 50% of infants born to mothers with type 1 diabetes and more than one third of infants born to mothers with type 2 diabetes met the criteria for being large for gestational age.
Birthweights as reflected by z scores also increased over time, from 1.22 for infants born to mothers with type 1 diabetes at the beginning of the study period to 1.47 for infants at study endpoint (P < .001).
For infants born to mothers with type 2 diabetes, birthweights remained relatively stable over the interval analyzed.
Type of Delivery: Cesarean Delivery Rates Increased All-round
The type of delivery also varied significantly between mothers with diabetes and those without. More than two thirds of women with type 1 diabetes underwent either elective or emergency cesarean delivery at the end of the study period, as did almost 60% of women with type 2 diabetes.
In contrast, rates of elective and emergency cesarean deliveries ranged between 10% and 15% for women without diabetes at the same assessment point.
Table. Proportion of Elective and Emergency Cesarean Deliveries at Study Endpoint
| Mothers With Type 1 Diabetes | Mothers With Type 2 Diabetes | Mothers Without Diabetes | |
|---|---|---|---|
| Elective cesarean deliveries | 29.4% | 30.5% | 9.6% |
| Emergency cesarean deliveries | 38.3% | 29.1% | 14.6% |
Cesarean delivery rates did increase significantly over the study period among nondiabetic mothers as well, from 6.8% to 11.8% for elective and from 11.8% to 15.1% for emergency cesarean deliveries (P < .001).
Increasing rates of obstetric intervention may reflect a combination of higher infant birthweights and an increased risk for perinatal complications, the authors speculate.
They could also reflect an increase in rates of placental insufficiency necessitating earlier delivery and changing obstetric behavior, the investigators add.
“There is a major unmet need to improve perinatal outcomes for women with diabetes treated during pregnancy. Novel approaches and technologies will be needed to address this,” they conclude.
Diabetologia. Published online January 11, 2018. Full text
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