Retrospective national cohort study of pregnancy outcomes for women with type 1 and type 2 diabetes mellitus in Republic of Ireland. (July 2022)

• Record Type: Journal Article
• Authors: Newman, Christine; Egan, Aoife M.; Ahern, Tomas; Al-Kiyumi, Maisa; Bacon, Siobhan; Bahaeldein, Elgelani; Balan, Gabriela; Brassill, Mary-Jane; Breslin, Emily; Brosnan, Elizabeth; Carmody, Louise; Clarke, Hilda; Coogan Kelly, Caroline; Culliney, Linda; Davern, Recie; Durkan, Maeve; Elhilo, Kalthoom; Cullen, Elizabeth; Fenlon, Mairead; Ferry, Pauline; Gabir, Ahmed; Guinan, Linda; Hanlon, Geraldine; Heffernan, Marie; Higgins, Tom; Hoashi, Shu; Kgosidialwa, Oratile; Khamis, Amjed; Kinsley, Brendan; Kirwan, Breda; James, Anne; Kyithar, Pyeh; Liew, Aaron; Malik, Ihtisham; Matthews, Linda; McGurk, Colm; McHugh, Cathy; Moloney, Yvonne; Murphy, Matt S; Murphy, Paula; Nagodra, Dina; Noctor, Eoin; Nolan, Marie; O'Connor, Aislong; O'Connor, Emily; O'Halloran, Domhnall; O'Mahoney, Linda; O'Shea, Triona; O'Sullivan, Eoin P.; Peters, Moby; Roberts, Graham; Rooney, Hannorah; Sharma, Jayant; Smyth, Aoife; Synnott, Maria; Tarachand, Bheesham; Tighe, Marie; Todd, Marie; Towers, Michael; Tuthill, Antoinette; Mahmood, Wan; Yousif, Obada; Dunne, Fidelma P.;
• Is Part Of: Diabetes research and clinical practice. Volume 189(2022)
• Publication Date: 2022-07
• Subjects: Congenital anomalies -- Diabetes -- Intra-uterine foetal death -- Pregnancy -- Large for gestational age; PPC Pre-pregnancy Clinic -- LGA Large for Gestational Age -- HbA1c Haemoglobin A1c -- DPSG Diabetes Prevention Study Group -- PGDM Pre-gestational Diabetes Mellitus -- RoI Republic of Ireland -- BMI Body Mass Index -- EmCS Emergency Caesarean Section -- PET Pre-eclampsia -- PIH Pregnancy Induced Hypertension -- SGA Small for Gestational Age -- NICU Neonatal Intensive Care Unit -- LADA Latent Autoimmune Diabetes of Adulthood -- MODY Maturity Onset Diabetes of the Young -- LMP Last Menstrual Period -- EHR Electronic Health Record -- CSII Continuous Subcutaneous Insulin Infusion -- CGM Continuous Glucose Monitoring -- ELCS Elective Caesarean Section -- IOM Institute of Medicine; Diabetes -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462
• DOI: 10.1016/j.diabres.2022.109947
• Languages: English
• ISSNs: 0168-8227

Abstract

Abstract: Aim: Report the outcomes of pregnant women with type 1 and type 2 diabetes and to identify modifiable and non-modifiable factors associated with poor outcomes. Methods: Retrospective analysis of pregnancy preparedness, pregnancy care and outcomes in the Republic of Ireland from 2015 to 2020 and subsequent multivariate analysis. Results: In total 1104 pregnancies were included. Less than one third attended pre-pregnancy care (PPC), mean first trimester haemoglobin A1c was 7.2 ± 3.6% (55.5 ± 15.7 mmol/mol) and 52% received pre-conceptual folic acid. Poor preparation translated into poorer pregnancy outcomes. Livebirth rates (80%) were comparable to the background population however stillbirth rates were 8.7/1000 (four times the national rate). Congenital anomalies occurred in 42.5/1000 births (1.5 times the background rate). More than half of infants were large for gestational age and 47% were admitted to critical care. Multivariate analyses showed strong associations between non-attendance at PPC, poor glycaemic control and critical care admission (adjusted odds ratio of 1.68 (1.48–1.96) and 1.61 (1.43–1.86), p < 0.05 respectively) for women with type 1 diabetes. Smoking and teratogenic medications were also associated with critical care admission and hypertensive disorders of pregnancy. Conclusion: Pregnancy outcomes in women with diabetes are suboptimal. Significant effort is needed to optimize the modifiable factors identified in this study.