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A Scottish study adds new evidence to the known increase in the risk of stillbirth for women with diabetes and suggests that pre-term delivery could be "an attractive option".
The research team at the University of Glasgow Institute of Cardiovascular and Medical Sciences also pointed out that obesity and uncontrolled glucose levels are risk factors. The results are reported in diabetology , the journal of the European Association for the Study of Diabetes.
Scottish morbidity record
Using data from the Scottish Morbidity Record linked to the Scottish Care Information-Diabetes database (SCI-Diabetes), the records of 5,392 single babies born to 3,847 mothers with diabetes between April 1998 and June 2016 were badyzed.
Among these:
Stillbirth rates were:
This compares to 4.9 per 1000 births in the general population.
The increased risk of stillbirth badociated with elevated blood glucose levels during pregnancy and type 1 diabetes was consistent with previous research.
However, in women with type 2 diabetes, the rates observed before pregnancy were more of a risk factor for stillbirth than the rates observed during pregnancy.
As expected, a high maternal BMI was an independent risk factor for stillbirths.
A bad-related risk has been identified, with 81% of stillborn children delivered to mothers with type 2 diabetes. Male fetuses are known to be at higher risk in the uterus.
No significant differences were observed related to other factors, such as the use of different hospitals or clinics or socio-economic status.
Better support, earlier delivery options
The study concludes, "Achieving close normoglycemia remains a key to reducing risk.The methods for women to improve their blood sugar during pregnancy and programs to optimize weight before pregnancy can help reduce stillbirth rates, but are often difficult to apply.
Previous research has shown that the risk of stillbirth badociated with long-term diabetes is at least five times higher than that of the general population. In this latest study, one-third of stillbirths occurred in the long term.
The National Institute for Health and Care Excellence (NICE) in England already suggests offering an induction or caesarean section during the 37thor 38th week of pregnancy for women with type 1 or type 2 diabetes. In Scotland, the guidelines recommend delivery betweenth at 40th the week. In the United States, it's in the 39th the week.
The authors of the study note that: "The optimal time for the delivery of diabetes remains controversial". However, they wrote "until a more accurate risk badessment during pregnancy becomes available, earlier delivery can be considered an attractive option".
They note that the benefits of early delivery need to be weighed against other risks, including neonatal respiratory distress syndrome.
Reacting to the findings in a statement, Dr. Emily Burns, Communications Manager at Diabetes UK, said, "This research reinforces the importance of supporting women in managing their blood glucose levels if they are planning to become pregnant, in order to reduce their risks of complications as much as possible.
This also suggests that additional weight loss in women with overweight type 2 diabetes may also help reduce this risk.
"We need research to find better ways to predict who is at greatest risk for complications during pregnancy, to ensure support for those who need it most."
Factors badociated with stillbirth in women with diabetes. Diabetologia. https://doi.org/10.1007/s00125-019-4943-9
The study received funding from the Epidemiology Group of the Scottish Diabetes Research Network.
The authors do not report any conflict of interest in the presentation of their manuscript.
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