OnMedica – News – Women with diabetes are more likely to have births

Hyperglycemia and BMI related to stillbirth in mothers with diabetes

Mothers with diabetes are at risk of stillbirth more than four times that of unaffected pregnant women, study * published in diabetology found.

Research has found that high blood sugar and BMI levels are risk factors for babies.

Although births have declined further in the general obstetric population in recent years, there has been no improvement in women with diabetes. While one-third of the stillbirths of mothers with diabetes occur near the end of their lives and could be influenced by childbirth policy, the majority occurs before 37 weeks. It is therefore essential to find better ways to detect babies at risk, said researchers at the University of Glasgow.

For the study, they linked the Scottish Morbidity Record 02 maternity records (SMR02) – a database containing clinical information on all birth episodes in Scotland – to Scottish Care Information-Diabetes (SCI-Diabetes) data – a database containing patient demographics and clinical information on the diagnosis, complications and management of diabetes.

They identified 5,392 isolated babies born to 3,847 mothers with diabetes (3,778 to 2,582 mothers of type 1 and 1,614 to 1,265 mothers of type 2), among whom stillbirth rates were 16.1 to 1 000 type 1 births and 22.9 per 1,000. Type 2 births, compared to 4.9 per 1,000 births in the general population.

The researchers found that maternal glucose levels were the main modifiable risk factor for stillbirths in pregnant women with diabetes. It was found that the average blood glucose of women with type 1 still-born diabetes was higher at all stages of pregnancy and that for type 2 diabetes, blood glucose before pregnancy, rather than during pregnancy, seemed to be a more important predictor of stillbirths. . Another risk factor for stillbirth in mothers with type 2 diabetes was a high maternal BMI.

In the general obstetrical population, the restriction of fetal growth, in that the unborn baby is smaller than expected, is the most powerful indicator of the risk of stillbirths. The researchers found a similar badociation in this group, especially for type 1 diabetes. Greater than gestational age is a risk factor in the general population, and so was diabetes type 2. Fetal proliferation is related to maternal hyperglycemia at the end of pregnancy. In this study, the researchers noted that even among mothers with the lowest blood glucose levels, the birth weight of the child was considerably higher than that of the general population.

"Achieving close to normal blood sugar levels remains essential for reducing risk," said the researchers, recommending "methods to help women improve their blood sugar during pregnancy, as well as programs to improve their blood sugar levels." optimizing weight before pregnancy ". Since the risk of stillbirth is high over time, the authors recommend that "until a more accurate badessment of risk during pregnancy becomes available, earlier delivery can be considered an attractive option." ".

Regular early delivery is generally recommended for mothers with diabetes, as the National Institute of Health and Care Excellence (NICE) guidelines suggest delivery at week 37 or week 38. Compared to the general population, women with diabetes are at increased risk of stillbirth in pregnancy at all stages of pregnancy. Previous studies have shown that over time, the risk is more than five times higher. In this study, one-third of stillbirths occurred in the long term.

"It would seem then that earlier delivery would be a wise approach," the researchers said. "However, due to potential problems badociated with early delivery, including respiratory distress syndrome resulting from insufficient lung development, we suggest that the increased risk of neonatal morbidity be explored more formally before making recommendations." on the optimal timing of delivery, mothers manage to achieve near normal blood sugar. "

Unexpectedly, in this study, a high proportion of stillborn babies (81%) were men among mothers with type 2 diabetes. Previous studies indicate that male fetuses are more vulnerable in utero, with an increased risk of stillbirth of about 10% compared to female newborns.

* Mackin ST, Nelson SM, Wild SH, et al. Factors badociated with stillbirth in women with diabetes. Diabetologia, July 29, 2019. DOI: 10.1007 / s00125-019-4943-9