Predictors for adverse pregnancy outcomes in women with pre-gestational diabetes: a retrospective study

Authors

  • Tsz Ching Leung Tuen Mun Hospital
  • Dong Yee Chan Tuen Mun Hospital
  • Lee Ting Kwong
  • Po Lam So

DOI:

https://doi.org/10.12809/hkjgom.24.2.371

Keywords:

Congenital abnormalities, Diabetes mellitus, Glycated hemoglobin, Pregnancy complications

Abstract

Objective: To identify predictors for adverse pregnancy outcomes among women with pre-gestational diabetes.
Methods: We retrospectively reviewed medical records of women with pre-gestational diabetes who attended the Tuen Mun Hospital between 1 January 2012 and 30 December 2022 for antenatal care and delivery. Composite adverse early perinatal outcomes included spontaneous fetal loss before 24 weeks and congenital malformations. Composite adverse maternal outcomes included pre-eclampsia and Caesarean section. Composite adverse neonatal outcomes included preterm delivery <37 weeks, small and large for gestational age, shoulder dystocia, hypoglycaemia, Apgar score <7 at 5 minutes, arterial cord blood pH <7.0, admission to a neonatal intensive care unit, stillbirth, and death within 28 days of life. Factors associated with adverse pregnancy outcomes were identified.
Results: Among 245 women included in analysis, there were 10 spontaneous pregnancy losses before 24 weeks, four stillbirths, and 41 congenital malformations, which resulted in four terminations of pregnancy. The glycated haemoglobin (HbA1c) level at the first antenatal visit was a predictor for composite adverse early perinatal outcomes (adjusted odds ratio [aOR]=1.27, p=0.013). The rate of congenital anomaly increased threefold from 10% when the HbA1c level was <5.6% to 37.1% when the HbA1c level was >9.1% (p=0.003). Predictors for composite adverse maternal outcomes were a pre-pregnancy body mass index ≥25 kg/m2 (aOR=2.04, p=0.033) and chronic hypertension (aOR=3.59, p=0.009), whereas the predictor for composite adverse neonatal outcomes were the HbA1c level before delivery (aOR=1.57, p=0.025). Pre-pregnancy medical care was associated with a lower maternal HbA1c level at the first antenatal visit (6.8% vs 8.2%, p=0.002) and earlier gestational age at the first antenatal visit (8 vs 12 weeks, p<0.001), compared with no pre-pregnancy medical care.
Conclusion: Maternal glycaemic control and body mass index are the major modifiable risk factors for adverse pregnancy outcomes in women with pre-gestational diabetes. Pre-pregnancy medical care should emphasise lowering the HbA1c level and bodyweight at early pregnancy to avoid adverse pregnancy outcomes.

References

Chivese T, Hoegfeldt CA, Werfalli M, et al. IDF Diabetes Atlas: the prevalence of pre-existing diabetes in pregnancy: a systematic review and meta-analysis of studies published during 2010-2020. Diabetes Res Clin Pract 2022;183:109049.

Tinker SC, Gilboa SM, Moore CA, et al. Specific birth defects in pregnancies of women with diabetes: National Birth Defects Prevention Study, 1997-2011. Am J Obstet Gynecol 2020;222:176.e1-176.e11.

Garne E, Loane M, Dolk H, et al. Spectrum of congenital anomalies in pregnancies with pregestational diabetes. Birth Defects Res A Clin Mol Teratol 2012;94:134-40.

Davidson AJF, Park AL, Berger H, et al. Association of improved periconception hemoglobin A1c with pregnancy outcomes in women with diabetes. JAMA Netw Open 2020;3:e2030207.

Evers IM, de Valk HW, Visser GH. Risk of complications of pregnancy in women with type 1 diabetes: nationwide prospective study in the Netherlands. BMJ 2004;328:915.

Macintosh MC, Fleming KM, Bailey JA, et al. Perinatal mortality and congenital anomalies in babies of women with type 1 or type 2 diabetes in England, Wales, and Northern Ireland: population based study. BMJ 2006;333:177.

Murphy HR, Howgate C, O’Keefe J, et al. Characteristics and outcomes of pregnant women with type 1 or type 2 diabetes: a 5-year national population-based cohort study. Lancet Diabetes Endocrinol 2021;9:153-64.

ElSayed NA, Aleppo G, Aroda VR, et al. Management of diabetes in pregnancy: standards of care in diabetes-2023. Diabetes Care 2023;46(Suppl 1):S254-S266.

Wahabi HA, Alzeidan RA, Esmaeil SA. Pre-pregnancy care for women with pre-gestational diabetes mellitus: a systematic review and meta-analysis. BMC Public Health 2012;12:792.

Wahabi HA, Fayed A, Esmaeil S, et al. Systematic review and meta-analysis of the effectiveness of pre-pregnancy care for women with diabetes for improving maternal and perinatal outcomes. PLoS One 2020;15:e0237571.

Sato T, Sugiyama T, Kurakata M, et al. Pregnancy outcomes in women with type 1 and type 2 diabetes mellitus in a retrospective multi-institutional study in Japan. Endocr J 2014;61:759-64.

Lepercq J, Le Ray C, Godefroy C, Pelage L, Dubois-Laforgue D, Timsit J. Determinants of a good perinatal outcome in 588 pregnancies in women with type 1 diabetes. Diabetes Metab 2019;45:191-6.

Cyganek K, Hebda-Szydlo A, Skupien J, et al. Glycemic control and pregnancy outcomes in women with type 2 diabetes from Poland. The impact of pregnancy planning and a comparison with type 1 diabetes subjects. Endocrine 2011;40:243-9.

Buhary BM, Almohareb O, Aljohani N, et al. Glycemic control and pregnancy outcomes in patients with diabetes in pregnancy: a retrospective study. Indian J Endocrinol Metab 2016;20:481-90.

Fok TF, So HK, Wong E, et al. Updated gestational age specific birth weight, crown-heel length, and head circumference of Chinese newborns. Arch Dis Child Fetal Neonatal Ed 2003;88:F229-F236.

Lok IWY, Kong MCW, To WWK. Updated gestational age specific birthweight reference of Hong Kong Chinese newborns and comparison with local and international growth charts. Open J Obstet Gynecol 2021;11:940-54.

Mackin ST, Nelson SM, Kerssens JJ, et al. Diabetes and pregnancy: national trends over a 15 year period. Diabetologia 2018;61:1081-8.

Lauenborg J, Mathiesen E, Ovesen P, et al. Audit on stillbirths in women with pregestational type 1 diabetes. Diabetes Care 2003;26:1385-9.

Rackham O, Paize F, Weindling AM. Cause of death in infants of women with pregestational diabetes mellitus and the relationship with glycemic control. Postgrad Med 2009;121:26-32.

Murphy HR, Bell R, Cartwright C, et al. Improved pregnancy outcomes in women with type 1 and type 2 diabetes but substantial clinic-to-clinic variations: a prospective nationwide study. Diabetologia 2017;60:1668-77.

Mackin ST, Nelson SM, Wild SH, et al. Factors associated with stillbirth in women with diabetes. Diabetologia 2019;62:1938-47.

Greene MF, Hare JW, Cloherty JP, Benacerraf BR, Soeldner JS. First-trimester hemoglobin A1 and risk for major malformation and spontaneous abortion in diabetic pregnancy. Teratology 1989;39:225-31.

Nakanishi K, Kanagawa T, Fujikawa K, Ishii K, Waguri M. Congenital malformation and hemoglobin A1c in the first trimester among Japanese women with pregestational diabetes. J Obstet Gynaecol Res 2021;47:4164-70.

Dude AM, Badreldin N, Schieler A, Yee LM. Periconception glycemic control and congenital anomalies in women with pregestational diabetes. BMJ Open Diabetes Res Care 2021;9:e001966.

Langer O, Yogev Y, Xenakis EM, Brustman L. Overweight and obese in gestational diabetes: the impact on pregnancy outcome. Am J Obstet Gynecol 2005;192:1768-76.

Negrato CA, Mattar R, Gomes MB. Adverse pregnancy outcomes in women with diabetes. Diabetol Metab Syndr 2012;4:41.

Gizzo S, Patrelli TS, Rossanese M, et al. An update on diabetic women obstetrical outcomes linked to preconception and pregnancy glycemic profile: a systematic literature review. ScientificWorldJournal 2013;2013:254901.

Murphy HR, Roland JM, Skinner TC, et al. Effectiveness of a regional prepregnancy care program in women with type 1 and type 2 diabetes: benefits beyond glycemic control. Diabetes Care 2010;33:2514-20.

Feig DS, Donovan LE, Corcoy R, et al. Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trial. Lancet 2017;390:2347-59.

Downloads

Published

2024-05-13

How to Cite

1.
Leung TC, Chan DY, Kwong LT, So PL. Predictors for adverse pregnancy outcomes in women with pre-gestational diabetes: a retrospective study. Hong Kong J Gynaecol Obstet Midwifery [Internet]. 2024 May 13 [cited 2024 Jul. 13];24(2). Available from: https://hkjgom.org/home/article/view/371

Issue

Section

Original Article

Most read articles by the same author(s)