A multicenter Italian study on pregnancy outcome in women with diabetes

https://doi.org/10.1016/j.numecd.2006.12.001Get rights and content

Abstract

Background and aim

To determine pregnancy outcome in women with type 1 and type 2 diabetes.

Methods and results

A prospective study was conducted in 33 centers in Italy between 1999 and 2003, mainly recording preterm delivery, stillbirths, neonatal mortality, congenital malformations and birthweight.

Of the 668 women examined, 504 had type 1 diabetes and 164 had type 2. Pre-pregnancy counseling had been provided to 43.9% of the women who had type 1 diabetes and 29.1% of the women who had type 2 diabetes and correlated with a better HbA1c value throughout pregnancy. The preterm delivery rate was significantly higher in type 1 and 2 diabetics than in normal pregnant women and was related to HbA1c values higher than 8%, gestational hypertension, pre-eclampsia and the presence of retinopathy before pregnancy. The stillbirth and neonatal mortality rates were also higher in diabetic pregnant women (1.26% and 0.63%, respectively) than in Italian pregnancies in general (0.30% and 0.32%), and the same was true for major congenital malformations (4.9% for diabetic pregnancies, 0.86% for normal Italian pregnancies).

Conclusions

In our population, pregnancy in diabetic women was still associated with a high rate of stillbirths, neonatal mortality and congenital malformations. Unplanned pregnancies and non-optimal glycemia control may help explain the high rates of maternal and neonatal complications.

Introduction

Diabetes mellitus complicates 0.3–0.5% of all pregnancies, annually involving approximately 15,000 women in Europe [1] and 19,000 in the USA [2]. In recent years, better maternal and fetal surveillance techniques have revolutionized care in pregnancies complicated by diabetes, and improved maternal and fetal outcome [3], [4], but women with diabetes still fare significantly worse than non-diabetic women [5], [6]. In 1989, the Regional Office of the World Health Organization and the International Diabetes Federation in St. Vincent established aims and a gold standard for diabetes care [7] so that “pregnancy outcome of diabetic women should approximate that of non-diabetic women”. But now, 17 years later, this goal has still to be reached.

The Diabetes Control and Complication Trial (DCCT) [8] and other intervention trials [9] showed that, in women with type 1 diabetes, good metabolic control at conception and throughout pregnancy can give maternal and fetal outcomes comparable to non-diabetic pregnancies. However, the intensive control exerted in a limited study setting is hard to reproduce in general clinical practice.

Large multicenter surveys on pregnancy outcome in diabetic women have been published in some European countries in recent years [10], [11], [12], [13], [14], but Italian data on this topic are still lacking, so we designed this study to document the general approach to pregnancies complicated by diabetes in Italy, and to evaluate the outcomes. Here we report the findings of the first five years of the study.

Section snippets

Methods

Since 1999, the Italian Diabetes and Pregnancy Study Group has been taking part in the WHO “Diabetes in Pregnancy Aggregated Data. European Pilot Project—Subproject Diabetes and Pregnancy”, designed to improve outcome and quality of care in this area by collecting and analyzing data from different countries [15]; the 33 Italian Centers involved agreed to take part in this prospective study.

All pregnant women with type 1 and 2 diabetes who delivered between January 1999 and December 2003 were

Results

During the study, each of the 33 centers supplied data concerning all diabetic pregnancies observed. The total was 668, 504 with type 1 and 164 with type 2 diabetes (all pregnancies were singleton); 20 of the centers were in Northern Italy (42% of pregnancies), six in the South (28%) and seven in Central Italy (30%). The number of pregnancies at each center ranged between 6 and 50.

Maternal details at booking are given in Table 1. Type 2 diabetic patients were significantly older and had a

Discussion

Almost completely normal obstetric and perinatal outcomes have been reported in clinical trials where strict metabolic control was achieved in selected groups of intensively treated diabetic women [9], but such positive results were not reached in recently published nationwide observational studies [10], [11], where the rate of congenital malformations in children born to diabetic women was still higher (3–6 times) than in the general population.

This multicenter survey, conducted in an

GISOGD (Gruppo Italiano di Studio degli Outcome delle Gravidanze Diabetiche, Italian Study Group of the Outcome of Pregnancies in Diabetic Women) Investigators

G. Stefanelli, F. Giorgino (Diabetology Bari); D. Faden, S. Zotti, A. Minelli, A. Cimino (Obstetrics and Diabetology, Brescia); P.P. Contini (Diabetology, Cagliari); A.M. Cospite, L. Confortin (Diabetology, Castelfranco Veneto, TV); R. Fresa, M. Agrusta (Diabetology, Cava dei Tirreni, SA); L. Corsi, G. Versari (Diabetology, Chiavari, GE); E. Vitacolonna, F. Capani (Diabetology, Chieti); G. Mello, E. Parretti, A. Magrini, E. Bartoli, F. Tondi, C. Riviello (Obstetrics, Firenze); T. Marcone

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    Members of the Coordination of the Italian Diabetes and Pregnancy Study Group, Società Italiana di Diabetologia (SID).

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