Stillbirths are more likely if diabetes during pregnancy is not diagnosed

According to a new study, women who develop diabetes during pregnancy but who are not diagnosed are much more likely to have a stillbirth.

The study, led by the University of Leeds and the University of Manchester, found that the risk of stillbirths was four times higher in women who had signs of gestational diabetes but were undiagnosed.

However, with appropriate screening and diagnosis, the increased risk of stillbirth has disappeared.

Funded by charities Action Medical Research, Cure Kids, Sands and Tommy's, the study compared the symptoms and care of 291 women who had a stillbirth to 733 similar women who did not have unbadisted delivery in 41 maternity homes in England.

The researchers found that in all women with high blood glucose measured after a fasting period, they were on average twice as likely to be born dead as women without any disease.

The increased risk was likely due to missed diagnoses and the lack of subsequent care of many women, although the results show badociation only and can not provide certainty about cause and effect.

The new research was published in BJOG: an international journal of obstetrics and gynecology.

Dr. Tomasina Stacey, who led the study at Leeds University and now works at Huddersfield University, said, "There is good news and bad news, and the good news is that of gestational diabetes have no increased risk of stillbirth if national guidelines are followed for screening, diagnosis and management.The bad news is that guidelines are not always followed and that some women are therefore at an avoidable risk. high. "

According to recent figures, about 5% of British women have gestational diabetes during pregnancy.

The National Institute for Care Excellence (NICE) recommends that all women at high risk of gestational diabetes be screened for blood, including women with high body mbad index (BMI> 30). ), South Asians or the United States. Black Caribbean ethnic groups.

Only 74.3% of participating women with a high BMI and 74.7% of participating women belonging to South Asian or Black Caribbean ethnic groups were screened.

On average, women at higher risk of gestational diabetes who were not screened according to NICE guidelines also had a higher risk of stillbirths.

Professor Alexander Heazell, co-author of the University of Manchester and Clinical Director of the Tommy & # 39; s Stillbirth Research Center, said: "It is unclear why some women have escaped the screening or diagnosis of gestational diabetes, but this needs to be improved.

"Gestational diabetes can lead to serious complications during pregnancy, and it is important to detect all women with symptoms so that they can receive appropriate care and support."

In 2015, NICE raised the diagnostic threshold for gestational diabetes to a fasting plasma glucose concentration (where blood glucose is measured after fasting) in excess of 5.6 mmol / L. In the United States, the threshold is 5.1 mmol / L and the appropriate level of diagnosis is very controversial worldwide.

The present study found little evidence to support one threshold over another, but rather that the risk of stillbirth increased steadily with increasing glucose concentration.

Dr. Stacey, who also works at the Calderdale and Huddersfield NHS Foundation Trust, added, "There is no blood sugar level where the risk suddenly increases, so the choice of the appropriate threshold for diagnosis is based more on pragmatism and finding the right balance of risk Our study shows that NICE's current recommendations can be effective, but only if they are followed. "

According to recent figures from MBBRACE-UK, about four out of every 1,000 births in the UK result in a stillbirth.

Commenting on the research, Dr. Edward Morris, Vice President of Clinical Quality for the Royal College of Obstetricians and Gynecologists, said, "Women with gestational diabetes are more likely to have stillbirths, but with surveillance, care and Adequate treatment, this risk can be managed so that women can maximize their chances of having a healthy pregnancy and childbirth.

"Maternity units should follow NICE's clinical guidelines to ensure that women are diagnosed and supported to avoid complications and to ensure the best possible outcomes."

This study is unique in separating the adverse biological effects of blood glucose on the benefits of diagnosis, which generally leads to better care and better disease management.

Dr. Peter Tennant, co-author of the University of Leeds and the Alan Turing Institute, explained why this is so important. He said: "The real impact of gestational diabetes is the subject of much debate. It is difficult to spend so much time and money on the screening, diagnosis and care of these mothers. But most women with diabetes currently receiving good care, seems to really help.

"It's only when you look at women who are not screened or diagnosed appropriately that the full impact of gestational diabetes becomes clear."

The research project came out of a summit on death at birth in 2011 and was created with the help of more than 550 parents and members of the public. It was designed by and for parents to maximize the positive impact it could have on society.

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University of Leeds