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Outcomes in type 1 diabetic pregnancies: a nationwide, population-based study
Dorte M Jensen1, Peter Damm, Lars Moelsted-Pedersen
1Department of Endocrinology, Odense University Hospital, Kløvervaenget 6 DK-5000, Odense, Denmark. dortemj@dadlnet.dk.
Diabetes Care
|November 25, 2004
Summary
Type 1 diabetic pregnancies have significantly higher risks of perinatal complications and congenital malformations compared to the general population. Improved glycemic control and daily glucose monitoring before and during pregnancy are crucial for better outcomes.
Area of Science:
- Reproductive Medicine
- Endocrinology
- Perinatology
Background:
- Type 1 diabetes in pregnancy presents unique challenges for both mother and fetus.
- Existing data suggest increased risks for adverse pregnancy outcomes, but comprehensive nationwide data are needed.
- Understanding these risks is crucial for developing targeted interventions.
Purpose of the Study:
- To compare pregnancy outcomes in women with type 1 diabetes mellitus (T1DM) against the background population.
- To identify factors associated with severe adverse pregnancy outcomes in T1DM.
- To evaluate the impact of maternal self-care and glycemic control on pregnancy outcomes.
Main Methods:
- A nationwide prospective multicenter study involving 990 women with 1,218 pregnancies in Denmark (1993-1999).
- Data collected prospectively by multiple caregivers per center and reported to a central registry.
- Comparison of outcomes including perinatal mortality, stillbirth, congenital malformations, and delivery modes with background population data.
Main Results:
- Type 1 diabetic pregnancies showed significantly higher rates of perinatal mortality (3.1% vs. 0.75%), stillbirth (2.1% vs. 0.45%), and congenital malformations (5.0% vs. 2.8%).
- Serious adverse outcomes were linked to higher HbA1c levels and poorer maternal self-care/preconceptional guidance.
- Daily glucose monitoring was associated with lower HbA1c and reduced adverse outcomes; C-section and preterm delivery rates were substantially higher.
Conclusions:
- Type 1 diabetic pregnancies face considerably higher rates of severe perinatal complications than the general population.
- Poor maternal self-care and inadequate glycemic control are key risk factors for adverse outcomes.
- Daily glucose monitoring and achieving adequate glycemic control before and during pregnancy are vital for improving outcomes, aligning with the St. Vincent declaration goals.