Pre-pregnancy diabetes raises risk of fetal/infant death
Risk of fetal and infant death is substantially increased in women with pre-existing diabetes, according to results of a new study in Diabetologia. The population-based analysis is one of few to exclude the effect of congenital anomalies and suggests that the association is largely influenced by glycemic control.
Risk of fetal and infant death is substantially increased in women with pre-existing diabetes, according to results of a new study in Diabetologia. The population-based analysis is one of few to exclude the effect of congenital anomalies and suggests that the association is largely influenced by glycemic control.
Researchers from Newcastle University, the South Tees National Health Services Trust, and Public Health England used the Northern Diabetes in Pregnancy Survey to identify all normally formed singleton infants born from 1996 to 2008 to women with pre-existing diabetes, 1206 with type 1 diabetes and 342 with type 2 diabetes. Population data from the Northern Perinatal Morbidity and Mortality Survey were used to estimate the relative risks (RR) of fetal death (≥20 weeks’ gestation) and infant death.
Fetal death was more than 4 times as prevalent in women with pre-existing diabetes as in those without the disease (RR 4.56; 95% confidence interval [CI] 3.42, 6.06; P < 0.0001). Relative risk (RR) of infant death was nearly double in diabetic women versus nondiabetics (RR 1.86; 95% CI 1.00, 3.46; P = 0.046). No difference was found in the rate of fetal death (P = 0.51) or infant death (P = 0.70) between women with Type 1 versus Type 2 diabetes. Lack of prepregnancy folic acid consumption (adjusted odd ratio [aOR] 2.55; 95% CI 1.12, 5.65; P = 0.03), prepregnancy retinopathy (aOR 2.05; 95% CI 1.04, 4.05; P = 0.04), and an increase in preconception HbA1c concentration above 49 mmol/mol (6.6%) (aOR 1.04; 95% CI 1.04, 4.05; P = 0.04) were all found to be independently associated with increase odds of fetal and infant death.
The investigators concluded that pre-existing diabetes carries a significantly increased risk of fetal and infant death, but that risk could be moderated with glycemic control. Given this significant risk, they said doctors should urge their patients to work with their diabetes team to get their glucose levels under control.
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