The role of modifiable pre-pregnancy risk factors in preventing adverse fetal outcomes among women with type 1 and type 2 diabetes

Melanie E. Inkster, Tom P. Fahey, Peter T. Donnan, Graham P. Leese, Gary J. Mires, Deirdre J. Murphy

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    Abstract

    We investigated the fetal outcomes of pregnancy in women with pre-existing diabetes in relation to pre-pregnancy risk factors using a community-based cohort of women in Tayside, Scotland. There were 211 pregnancies in 132 women with insulin-requiring type 1 and 2 diabetes between January 1993 and December 2005. Adverse fetal outcome was classified as spontaneous miscarriage, termination for medical reasons, stillbirth, neonatal death, or congenital malformation and occurred in 61 (29%) pregnancies. Mothers with poor glycemic control pre-conceptually and at booking (HbA1c=7.5%) had almost a three-fold increase in adverse fetal outcome compared with mothers having fair control, odds ratio (OR) 2.59 (95% CI 1.11-6.03), and 2.71 (95% CI 1.39-5.28), respectively. Mothers who were still smoking at the booking visit had a two-fold increase in adverse fetal outcome (OR 2.12, 95% CI 1.09-4.10). Further improvement in the management of diabetes and pregnancy is needed through enhanced preconception services addressing the full spectrum of modifiable risk factors.

    Original languageEnglish
    Pages (from-to)1153-1157
    Number of pages5
    JournalActa Obstetricia et Gynecologica Scandinavica
    Volume88
    Issue number10
    DOIs
    Publication statusPublished - 2009

    Keywords

    • Adverse fetal outcome
    • cohort study
    • pre-existing diabetes
    • pre-pregnancy risk factors
    • CONGENITAL-ANOMALIES
    • EARLY-PREGNANCY
    • MELLITUS
    • NATIONWIDE
    • SCOTLAND
    • ENGLAND

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