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Pre-Gestational Diabetes and Pregnancy Outcomes
Dalal S Ali1,2, Recie Davern1,2,3, Eimear Rutter2
1Endocrinology Department, Mater Misericordiae University Hospital, Dublin, Ireland.
Summary
Pregnancy outcomes in women with pre-gestational diabetes show type 2 diabetes is linked to higher BMI and better control. Continuous subcutaneous insulin infusion use correlated with increased miscarriage and malformation rates.
Area of Science:
- Obstetrics and Gynecology
- Endocrinology
- Neonatal Health
Background:
- Pre-gestational diabetes mellitus (PGDM), encompassing type 1 and type 2 diabetes, is a significant risk factor for adverse neonatal outcomes.
- PGDM is also associated with elevated rates of emergency cesarean sections, posing challenges in obstetric management.
Purpose of the Study:
- To investigate pregnancy outcomes in women with pre-gestational diabetes mellitus.
- To compare outcomes between type 1 and type 2 diabetes mellitus.
- To evaluate the impact of different insulin treatment modalities on pregnancy and neonatal outcomes.
Main Methods:
- A cohort study of 174 women with pre-gestational diabetes attending the National Maternity Hospital, Dublin, Ireland (2015-2017).
- Data collected included diabetes type, demographics, glycemic control (HbA1c), insulin delivery method, and pregnancy/neonatal outcomes.
- Statistical analysis was performed to compare outcomes between different groups.
Main Results:
- The cohort comprised 28.6% with type 2 diabetes mellitus (T2DM) and 71.4% with type 1 diabetes mellitus (T1DM).
- Women with T2DM were older, had higher BMI, and shorter diabetes duration but better glycemic control (HbA1c) at booking compared to T1DM.
- Continuous subcutaneous insulin infusion (CSII) use was associated with higher rates of miscarriage and congenital malformations compared to multiple dose injections (MDI).
- Cesarean delivery rate was 45.4%; CSII group had more emergency cesareans, while MDI group had more elective cesareans.
Conclusions:
- Women with PGDM in this cohort were often overweight, older, and had long-standing diabetes.
- T2DM patients exhibited distinct characteristics including higher BMI, older age, shorter diabetes duration, and better glycemic control than T1DM patients.
- CSII treatment was linked to increased adverse fetal outcomes, including miscarriage and congenital malformations.
- Diabetes control generally improved during pregnancy across the cohort.
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