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Maternal Diabetes, Fetal Growth, and Stillbirth Risk: A Population-Wide Retrospective Cohort Study From Victoria,

Hannah G Gordon1,2, Alexis Shub1,2, Susan P Walker1,2

  • 1Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Victoria, Australia.

Diabetes Care
|September 3, 2025
PubMed

Insights

Gestational diabetes in pregnancy is linked to lower stillbirth risk, possibly due to increased monitoring. However, preexisting diabetes significantly elevates stillbirth risk, especially for large babies, necessitating close surveillance.

Area of Science:

  • Perinatal epidemiology
  • Maternal-fetal medicine
  • Endocrinology

Background:

  • Diabetes in pregnancy (DIP) encompasses gestational diabetes (GDM) and pre-existing diabetes (Type 1 and Type 2).
  • DIP is a significant risk factor for adverse perinatal outcomes, including macrosomia and stillbirth.
  • Understanding the nuanced relationship between different types of DIP, birth weight, and stillbirth is crucial for optimizing obstetric care.

Purpose of the Study:

  • To investigate the association between diabetes in pregnancy (including GDM, Type 1, and Type 2 diabetes) and stillbirth risk.
  • To examine the impact of maternal diabetes on infant birth weight percentiles.
  • To analyze stillbirth risk across various birth weight centiles stratified by diabetes type.

Main Methods:

  • A population-based cohort study utilizing linked perinatal and diabetes data from Victoria, Australia (2009-2020).
  • Inclusion of all singleton births (n=860,042), with a focus on pregnancies with diabetes (n=100,856).
  • Assessment of birth weight centiles (<10th, >97th), stillbirth probability by birth weight centile, and stillbirth rates across gestational age for each diabetes subgroup.

Main Results:

  • Women with any form of diabetes in pregnancy delivered earlier and had higher rates of iatrogenic births compared to those without diabetes.
  • Gestational diabetes (diet or insulin-controlled) was associated with a reduced risk of stillbirth compared to no diabetes.
  • Pre-existing diabetes (Type 1 and Type 2) was significantly associated with an increased risk of stillbirth, particularly in infants with birth weight above the 97th centile (macrosomia).

Conclusions:

  • Gestational diabetes may be associated with a lower stillbirth risk, potentially due to heightened surveillance and earlier delivery interventions.
  • Pre-existing diabetes presents a substantially higher stillbirth risk, with macrosomic infants being a particularly vulnerable group.
  • Close monitoring of pregnancies complicated by pre-existing diabetes, especially those with suspected fetal macrosomia, is essential to mitigate stillbirth risk.
Abstract

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