Stillbirth in diabetic pregnancies.

Area of Science:

• Obstetrics and Gynecology
• Endocrinology
• Perinatology

Background:

• Pregnancy in women with pregestational diabetes mellitus (PGDM) is linked to elevated perinatal morbidity and mortality.
• Stillbirth represents the predominant cause of perinatal death in this high-risk population.
• While intrauterine growth restriction, pre-eclampsia, fetal hypoxia, and congenital malformations are implicated, over half of stillbirths remain unexplained.

Purpose of the Study:

• To highlight the critical role of suboptimal glycaemic control in stillbirths among pregnant women with PGDM.
• To identify fetal hypoxia and cardiac dysfunction as key pathogenic factors.
• To emphasize the need for improved glycaemic control strategies and management of hypertensive disorders during pregnancy.

Main Methods:

• Review of existing literature on stillbirths in pregestational diabetes.
• Analysis of contributing factors including glycaemic control, fetal hypoxia, and cardiac function.
• Evaluation of current antenatal surveillance methods such as ultrasound, kick counting, and non-stress testing.

Main Results:

• Suboptimal glycaemic control is a common characteristic of pregnancies resulting in stillbirth.
• Fetal hypoxia and cardiac dysfunction, secondary to poor glycaemic control, are likely major contributors to stillbirth.
• Current antenatal surveillance tests may not be sufficient to identify all fetuses at risk.

Conclusions:

• Enhanced strategies for achieving near-normal glycaemic control throughout pregnancy are essential.
• Effective prevention and treatment of hypertensive disorders in pregnancy are critical.
• Further research is needed to develop superior antenatal surveillance tests for early identification of fetuses susceptible to stillbirth.