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[Pregnancy and type 2 diabetes: which fetal prognosis?]
S Hiéronimus1, C Cupelli, M Durand-Réville
1Service d'endocrinologie-médecine de la reproduction, hôpital de l'Archet, CHU de Nice, BP 3079, 06202 Nice 3, France. hieronimus.s@chu-nice.fr
Objectives:
The rise in the prevalence of type 2 diabetes in women of childbearing age leads to an increasing number of pregnant women with type 2 diabetes. But published data on fetal outcome are scarce.
Patients And Methods:
In a prospective study from 1999 to 2002, we assessed fetal outcome (preterm delivery, perinatal mortality, congenital malformations) in 20 pregnancies associated with type 2 diabetes and compared the outcome to 40 pregnancies associated with type 1 diabetes.
Results:
Women with type 2 diabetes are older (32 +/- 5 vs. 27 +/- 5, P = 0.003), more obese (body mass index: 28.3 +/- 4.8 vs. 22.8 +/- 5.5, P < 0.001) than women with type 1 diabetes. Their pregnancy usually is not planned (10% vs. 55%, P < 0.001). HbA1c during organogenesis is above 8% in 46.6% of type 2 vs. 26.4% of type 1 (P < 0.001). Compared with data obtained in the general population, a fivefold increase in preterm delivery (26.3% vs. 4.7%), a sevenfold increase in perinatal mortality (5% vs. 0.7%) and congenital malformations (15.8% vs. 2.2%) are observed. These results are similar to those obtained in type 1. In planned pregnancy, HbA1c during organogenesis is under 7% with no perinatal death and no major congenital malformation.
Discussion And Conclusion:
Pregnancy complicated by type 2 diabetes is a high-risk one, as much as in type 1 diabetes. Efficient pre-pregnancy care needs to be strongly encouraged in women with type 2 diabetes who also display many risk factors for adverse fetal outcome.