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Acta Diabetologica

Erschienen in:

09.04.2021 | Original Article

Pregnancy outcomes and maternal characteristics in women with pregestational and gestational diabetes: a retrospective study on 206,917 singleton live births

verfasst von: Elisa Gualdani, Graziano Di Cianni, Marta Seghieri, Paolo Francesconi, Giuseppe Seghieri

Erschienen in: Acta Diabetologica | Ausgabe 9/2021

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Abstract

Aims

To examine risk of adverse pregnancy outcomes, mothers’ characteristics and incidence rate over time of pregestational type 1 (T1D), type 2 (T2D) or gestational diabetes (GDM).

Methods

The study included all singleton live births born from women aged 15–45 year, in Tuscany, Italy from 2010 to 2018. Pregnancy outcomes were retrieved by certificates of care at delivery compiled by midwives. Pregestational diabetes and GDM were identified by regional administrative databases. Time course of pregestational diabetes and GDM across last decade was assessed by Poisson analysis. Logistic regression analysis was used to calculate adjusted odds ratios (OR; 95% CI) for maternal characteristics or neonatal outcomes.

Results

Among 206,917 singleton live births, GDM was diagnosed in 21,613 pregnancies (10.46%) and pregestational diabetes in 979, being T2D more prevalent than T1D (606; 0.29% vs. 373; 0.18%). Pregestational T2D incidence progressively decreased over last decade, T1D remained stable while GDM progressively rose. Pre-pregnancy obesity, preterm deliveries or cesarean sections were common characteristics of pregestational diabetes and GDM. Risk of neonatal distress and neonatal malformations was higher in pregestational T1D. Risk of prior spontaneous abortions was higher in GDM and in pregestational T2D (OR: 4.19; 3.30–5.33), mostly treated with metformin. Risk of neonatal macrosomia was increased only in pregestational diabetes.

Conclusions

In our population, pregestational T2D was more prevalent than T1D. Neonatal complications were mostly associated with pregestational T1D. Increased risk of previous spontaneous abortions was the hallmark of pregestational T2D. GDM, even if sharing adverse outcomes with pregestational T2D, was unrelated to rise in risk of neonatal macrosomia.

Scavini M, Secchi A (2019) Diabetes in pregnancy. Acta Diabetol 56(7):719–721. https://doi.org/10.1007/s00592-019-01364-zCrossRefPubMed

Wintfeld N (2015) Trends in the incidence of diabetes, its clinical sequelae, and associated costs in pregnancy. Diabetes Metab Res Rev 31(7):707–716CrossRef

Chaovarindr U, Coustan DR, Hadden DR et al (2008) Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 358(19):1991–2002CrossRef

Gray SG, Sweeting AN, McGuire TM, Cohen N, Ross GP, Little PJ (2018) Changing environment of hyperglycemia in pregnancy: gestational diabetes and diabetes mellitus in pregnancy. J Diabetes 10(8):633–640CrossRef

Stogianni A, Lendahls L, Landin-Olsson M, Thunander M (2019) Obstetric and perinatal outcomes in pregnancies complicated by diabetes, and control pregnancies, in Kronoberg Sweden. BMC Pregnancy Childbirth 19(1):159. https://doi.org/10.1186/s12884-019-2269-8CrossRefPubMedPubMedCentral

Sugrue R, Zera C (2018) Pregestational diabetes in pregnancy. Obstet Gynecol Clin N Am 45(2):315–331. https://doi.org/10.1016/j.ogc.2018.01.002CrossRef

Wu Y, Liu B, Sun Y et al (2020) Association of maternal prepregnancy diabetes and gestational diabetes mellitus with congenital anomalies of the newborn. Diabetes Care 43(12):2983–2990. https://doi.org/10.2337/dc20-0261CrossRefPubMed

Helman S, James-Todd TM, Wang Z et al (2020) Time trends in pregnancy-related outcomes among women with type 1 diabetes mellitus, 2004–2017. J Perinatol 40(8):1145–1153. https://doi.org/10.1038/s41372-020-0698-xCrossRefPubMedPubMedCentral

Capobianco G, Gulotta A, Tupponi G et al (2020) Materno-fetal and neonatal complications of diabetes in pregnancy: a retrospective study. J Clin Med 9(9):2707. https://doi.org/10.3390/jcm9092707CrossRefPubMedCentral

10.

Shub A, Lappas M (2020) Pregestational diabetes in pregnancy: complications, management, surveillance, and mechanisms of disease—a review. Prenat Diagn 40(9):1092–1098. https://doi.org/10.1002/pd.5718CrossRefPubMed

11.

Billionnet C, Mitanchez D, Weill A et al (2017) Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012. Diabetologia 60(4):636–644. https://doi.org/10.1007/s00125-017-4206-6CrossRefPubMedPubMedCentral

12.

Mackin ST, Nelson SM, Kerssens JJ et al (2018) Diabetes and pregnancy: national trends over a 15 year period. Diabetologia 61(5):1081–1088. https://doi.org/10.1007/s00125-017-4529-3CrossRefPubMedPubMedCentral

13.

Gini R, Francesconi P, Mazzaglia G et al (2013) Chronic disease prevalence from Italian administrative databases in the VALORE project: a validation through comparison of population estimates with general practice databases and national survey. BMC Public Health 13:15. https://doi.org/10.1186/1471-2458-13-15CrossRefPubMedPubMedCentral

14.

Di Cianni G, Gualdani E, Berni C et al (2017) Screening for gestational diabetes in Tuscany, Italy. A population study. Diabetes Res Clin Pract 132:149–156. https://doi.org/10.1016/j.diabres.2017.08.003CrossRefPubMed

15.

Borsari L, Malagoli C, Ballotari P et al (2017) Validity of hospital discharge records to identify pregestational diabetes in an Italian population. Diabetes Res Clin Pract 123:106–111. https://doi.org/10.1016/j.diabres.2016.11.023]CrossRefPubMed

16.

Peng TY, Ehrlich SF, Crites Y et al (2017) Trends and racial and ethnic disparities in the prevalence of pregestational type 1 and type 2 diabetes in Northern California: 1996–2014. Am J Obstet Gynecol 216(2):177.e1-177.e8. https://doi.org/10.1016/j.ajog.2016.10.007CrossRef

17.

Lapolla A, Dalfrà MG, Di Cianni G, Bonomo M, Parretti E, Mello G; Scientific Committee of the GISOGD Group (2008) A multicenter Italian study on pregnancy outcome in women with diabetes. Nutr Metab Cardiovasc Dis 18(4):291–297. https://doi.org/10.1016/j.numecd.2006.12.001

18.

Scavini M, Rossi MC, Scardapane M et al (2018) Portrait of women with type 1 or type 2 diabetes of childbearing age attending diabetes clinics in Italy: the AMD-Annals initiative. Acta Diabetol 55(2):193–199. https://doi.org/10.1007/s00592-017-1076-9CrossRefPubMed

19.

http://dati.istat.it/Index.aspx?DataSetCode=DCIS_INDDEMOG1. Last accessed on 20 Dec 2020

20.

Seghieri G, Di Cianni G, Seghieri M et al (2020) Risk and adverse outcomes of gestational diabetes in migrants: a population cohort study. Diabetes Res Clin Pract 163:108128. https://doi.org/10.1016/j.diabres.2020.108128CrossRefPubMed

21.

Kong L, Nilsson IAK, Gissler M, Lavebratt C (2019) Associations of maternal diabetes and body mass index with offspring birth weight and prematurity. JAMA Pediatr 173(4):371–378. https://doi.org/10.1001/jamapediatrics.2018.5541 (PMID: 30801637)CrossRefPubMedPubMedCentral

22.

McGrath RT, Glastras SJ, Hocking SL, Fulcher GR (2018) Large-for-gestational-age neonates in type 1 diabetes and pregnancy: contribution of factors beyond hyperglycemia. Diabetes Care 41(8):1821–1828CrossRef

23.

McGrath RT, Glastras SJ, Seeho SK, Scott ES, Fulcher GR, Hocking SL (2017) Association between glycemic variability, HbA1c, and large-for-gestational-age neonates in women with type 1 diabetes. Diabetes Care 40(8):e98–e100. https://doi.org/10.2337/dc17-0626CrossRefPubMed

24.

Maresh MJ, Holmes VA, Patterson CC et al (2015) Diabetes and pre-eclampsia intervention trial study group, glycemic targets in the second and third trimester of pregnancy for women with type 1 diabetes. Diabetes Care 38(1):34–42. https://doi.org/10.2337/dc14-1755CrossRefPubMed

25.

Vally F, Presneill J, Cade T (2017) Macrosomia rates in women with diet-controlled gestational diabetes: a retrospective study. J Pregnancy 2017:4935397. https://doi.org/10.1155/2017/4935397CrossRefPubMedPubMedCentral

26.

Bianchi C, de Gennaro G, Romano M et al (2018) Pre-pregnancy obesity, gestational diabetes or gestational weight gain: Which is the strongest predictor of pregnancy outcomes? Diabetes Res Clin Pract 144:286–293. https://doi.org/10.1016/j.diabres.2018.08.019CrossRefPubMed

27.

Wei Y, Xu Q, Yang H et al (2019) Preconception diabetes mellitus and adverse pregnancy outcomes in over 64 million women: a population-based cohort study in China. PLoS Med 16(10):1002926. https://doi.org/10.1371/journal.pmed.1002926CrossRef

28.

Chaves C, Cunha F, Martinho M et al (2021) Metformin combined with insulin in women with gestational diabetes mellitus: a propensity score-matched study. Acta Diabetol. https://doi.org/10.1007/s00592-020-01665-8CrossRefPubMed

29.

Panchaud A, Rousson V, Vial T et al (2018) Pregnancy outcomes in women on metformin for diabetes or other indications among those seeking teratology information services. Br J Clin Pharmacol 84(3):568–578. https://doi.org/10.1111/bcp.13481CrossRefPubMedPubMedCentral

30.

Palomba S, Falbo A, Orio F Jr, Zullo F (2009) Effect of preconceptional metformin on abortion risk in polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials. Fertil Steril 92(5):1646–1658. https://doi.org/10.1016/j.fertnstert.2008.08.087CrossRefPubMed

31.

Nuti S, Bonini A, Murante AM, Vainieri M (2009) Performance assessment in the maternity pathway in Tuscany region. Health Serv Manage Res 22(3):115–121. https://doi.org/10.1258/hsmr.2008.008017CrossRefPubMed

32.

Balsells M, García-Patterson A, Gich I, Corcoy R (2009) Maternal and fetal outcome in women with type 2 versus type 1 diabetes mellitus: a systematic review and metaanalysis. J Clin Endocrinol Metab 94(11):4284–4291. https://doi.org/10.1210/jc.2009-1231CrossRefPubMed

Titel: Pregnancy outcomes and maternal characteristics in women with pregestational and gestational diabetes: a retrospective study on 206,917 singleton live births
verfasst von: Elisa Gualdani
Graziano Di Cianni
Marta Seghieri
Paolo Francesconi
Giuseppe Seghieri
Publikationsdatum: 09.04.2021
Verlag: Springer Milan
Erschienen in: Acta Diabetologica / Ausgabe 9/2021
Print ISSN: 0940-5429
Elektronische ISSN: 1432-5233
DOI: https://doi.org/10.1007/s00592-021-01710-0

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