Pregnancy of women with type 1 diabetes mellitus – the effect of preconception care on perinatal results. Ten years of experience
Authors:
Anderlová Kateřina 1,2; Krejčí Hana 1,2; Pařízek Antonín 2; Haluzík Martin 3; Kršek Michal 1; Krejčí Vratislav 2; Benešová Dana 2; Šimják Patrik 2
Authors‘ workplace:
III. interní klinika 1. LF UK a VFN v Praze
1; Gynekologicko-porodnická klinika 1. LF UK a VFN v Praze
2; Centrum diabetologie, IKEM Praha
3
Published in:
Ceska Gynekol 2021; 86(5): 318-324
Category:
Original Article
doi:
https://doi.org/10.48095/cccg2021318
Overview
Introduction: Despite the ever-improving medical care, pregnancies of women with type 1 diabetes mellitus (T1DM) are at increased risk of complications for both mother and child. Optimal compensation of diabetes before and during pregnancy is an essential protective factor reducing the risk of congenital malformations, pregnancy loss, and other complications. The pregnancy of women with T1DM should be planned, ideally at a time of optimal diabetes compensation. Target glycated hemoglobin (HbA1c) values until the range of 42–48 mmol/mol should be achieved at least three months before pregnancy. Our work aimed to evaluate the perinatal results of pregnancies in women with T1DM and the eff ect of preconception counseling and adequate T1DM compensation before pregnancy on perinatal outcomes. Methods and results: Retrospective analysis of pregnancy and perinatal outcomes of women with T1DM were followed up at the Department of Gynecology and Obstetrics, General University Hospital in Prague and First Faculty of Medicine, Charles University between 2008 to 2018. A total of 221 women with T1DM were included in the analysis. Adequate (HbA1c ≤ 48 mmol/mol at least 3 months before conception) and inadequate diabetes compensation at the beginning of the pregnancy had 59 (26.7%) and 162 (72.3%) women, respectively. Pregnancies of women with adequate diabetes compensation were more often planned (55.9 vs. 24.7%; P < 0.0001), had a lower incidence of any form of diabetic microangiopathy (13.6 vs. 37.7%; P = 0.001), pre-eclampsia (0 vs. 6.8%; P = 0.036), better compensation of diabetes during pregnancy (mean HbA1c during pregnancy 39.9 ± 6.7 vs. 49.9 ± 12.2; P < 0.0001), and their pregnancy was less often terminated from medical indication (congenital malformation of the fetus or decompensation of T1DM) (0 vs. 7.4%; P = 0.032). Pregnancies of women with adequate diabetes compensation before conception were less often complicated by fetal macrosomia (birth weight > 95th percentile; 22.0 vs. 35.8%; P = 0.027). Conclusion: The pregnancy of women with T1DM is burdened by a number of perinatal and neonatal complications. In the study group, most women with T1DM became pregnant unintentionally at a time of inadequate diabetes compensation. Women who achieved adequate diabetes compensation before pregnancy had a lower incidence of perinatal complications. Therefore, it is advised that women with T1DM should plan their pregnancy, attend preconception and antenatal care, and give birth in perinatal centers, which provide coordinated care from diabetologists, gynecologists, obstetricians, and neonatologists.
Keywords:
perinatal outcomes – type 1 diabetes mellitus – preconceptual counseling
Sources
1. 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 (7560): 177. doi: 10.1136/bmj.38856.692986.AE.
2. Pearson DW, Kernaghan D, Lee R et al. The relationship between pre-pregnancy care and early pregnancy loss, major congenital anomaly or perinatal death in type I diabetes mellitus. BJOG 2007; 114 (1): 104–107. doi: 10.1111/j.1471-0528.2006.01145.x.
3. Wren C, Birrell G, Hawthorne G. Cardiovascular malformations in infants of diabetic mothers. Heart 2003; 89 (10): 1217–1220. doi: 10.1136/ heart.89.10.1217.
4. Farrar D, Simmonds M, Bryant M et al. Hyperglycaemia and risk of adverse perinatal outcomes: systematic review and meta-analysis. BMJ 2016; 354: i4694. doi: 10.1136/bmj.i4694.
5. Yang J, Cummings EA, O’connell C et al. Fetal and neonatal outcomes of diabetic pregnancies. Obstet Gynecol 2006; 108 (3 Pt 1): 644–650. doi: 10.1097/01.AOG.0000231688.08263.47.
6. Persson M, Norman M, Hanson U. Obstetric and perinatal outcomes in type 1 diabetic pregnancies: a large, population-based study. Diabetes Care 2009; 32 (11): 2005–2009. doi: 10.2337/dc09-0656.
7. Stotland NE, Caughey AB, Breed EM et al. Risk factors and obstetric complications associated with macrosomia. Int J Gynaecol Obstet 2004; 87 (3): 220–226. doi: 10.1016/j.ijgo.2004.08.010.
8. Hajj NE, Scheider E, Lehnen H et al. Epigenetics and life-long consequences of an adverse nutritional and diabetic intrauterine environment. Reproduction 2014; 148 (6): R111–R120. doi: 10.1530/REP-14-0334.
9. Duckitt K, Harrington D. Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. BMJ 2005; 330 (7491): 565. doi: 10.1136/bmj.38380.674340.E0.
10. McElvy SS, Miodovnik M, Rosenn B et al. A focused preconceptional and early pregnancy program in women with type 1 diabetes reduces perinatal mortality and malformation rates to general population levels. J Matern Fetal Med 2000; 9 (1): 14–20. doi: 10.1002/ (SICI) 1520-6661 (200001/02) 9: <14:: AID-MFM5>3.0.CO; 2-K.
11. Kitzmiller JL, Block JM, Brown FM et al. Managing preexisting diabetes for pregnancy: summary of evidence and consensus recommendations for care. Diabetes Care 2008; 31 (5): 1060–1079. doi: 10.2337/dc08-9020.
12. Diabetes in pregnancy: management from preconception to the postnatal period. Nice: National Institute for Health and Care Excellence 2015.
13. Egan AM, Danyliv A, Carmody L et al. A prepregnancy care program for women with diabetes: effective and cost saving. J Clin Endocrinol Metab 2016; 101 (4): 1807–1815. doi: 10.1210/jc.2015-4046.
14. 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 (12): 2514–2520. doi: 10.2337/dc10-1113.
15. American Diabetes Association. Management of diabetes in pregnancy: standards of medical care in diabetes-2021. Diabetes Care 2021; 44 (Suppl 1): S200–S210. doi: 10.2337/ dc21-S014.
16. Berger H, Gagnon R, Sermer M et al. Diabetes in pregnancy. J Obstet Gynaecol Can 2016; 38 (7): 667–679. doi: 10.1016/j.jogc.2016.04.002.
17. Hawthorne G, Robson S, Ryall EA et al. Prospective population based survey of outcome of pregnancy in diabetic women: results of the Northern Diabetic Pregnancy Audit, 1994. BMJ 1997; 315 (7103): 279–281. doi: 10.1136/bmj.315.7103.279.
18. Jensen DM, Damm P, Moelsted-Pedersen L et al. Outcomes in type 1 diabetic pregnancies: a nationwide, population-based study. Diabetes Care 2004; 27 (12): 2819–2823. doi: 10.2337/diacare.27.12.2819.
19. Bell R, Bailey K, Cresswell T et al. Trends in prevalence and outcomes of pregnancy in women with pre-existing type I and type II diabetes. BJOG 2008; 115 (4): 445–452. doi: 10.1111/j.1471-0528.2007.01644.x.
20. Holing EV, Beyer CS, Brown ZA et al. Why don’t women with diabetes plan their pregnancies? Diabetes Care 1998; 21 (6): 889–895. doi: 10.2337/diacare.21.6.889.
21. Zhang J, Zeisler J, Hatch MC et al. Epidemiology of pregnancy-induced hypertension. Epidemiol Rev 1997; 19 (2): 218–232. doi: 10.1093/oxfordjournals.epirev.a017954.
22. Vlk R, Procházka M. Hypertenzní onemocnění v těhotenství. Ceska Gynekol 2018; 83 (2): 145–154.
23. Temple RC, Aldridge VJ, Murphy HR et al. Prepregnancy care and pregnancy outcomes in women with type 1 diabetes. Diabetes Care 2006; 29 (8): 1744–1749. doi: 10.2337/dc05-2265.
Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicineArticle was published in
Czech Gynaecology
2021 Issue 5
Most read in this issue
- Pregnancy of women with type 1 diabetes mellitus – the effect of preconception care on perinatal results. Ten years of experience
- Pigmented vulvar lesions – review and case report focusing on pigmented basal cell carcinoma
- In water or on land? Evaluation of perinatal and neonatal outcomes of water births in low-risk women
- Conservative possibilities influencing PCOS syndrome – the importance of nutrition