Contemporary type 1 diabetes pregnancy outcomes

Impact of obesity and glycaemic control

Sally K Abell, Jacqueline A Boyle, Barbora de Courten, Michell Knight, Sanjeeva Ranasinha, John Regan, Georgia Soldatos, Euan M Wallace, Sophia Zoungas, Helena J Teede

Research output: Contribution to journalArticleResearchpeer-review

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Abstract

OBJECTIVE: To compare contemporary pregnancy outcomes in women with and without type 1 diabetes, and to examine the effects of obesity and glycaemic control on these outcomes.DESIGN AND SETTING: Historical cohort study in a specialist diabetes and maternity network in Victoria.PARTICIPANTS: All singleton births (at least 20 weeks' gestation), 2010-2013, were analysed: 107 pregnancies to women with type 1 diabetes and 27 075 pregnancies to women without diabetes. Women with type 2 diabetes or gestational diabetes were excluded.METHODS: Data were extracted from the Birthing Outcomes System database; associations between type 1 diabetes and pregnancy outcomes were analysed by multivariable regression.MAIN OUTCOME MEASURES: Mode of birth; maternal and neonatal outcomes.RESULTS: The mean body mass index was higher for women with type 1 diabetes than for women without diabetes (mean, 27.3 kg/m(2) [SD, 5.0] v 25.7 kg/m(2) [SD, 5.9]; P = 0.01); the median gestation period for their babies was shorter (median, 37.3 weeks [IQR, 34.6-38.1] v 39.4 weeks [IQR, 38.4-40.4]; P < 0.001) and they were more likely to be large for gestational age (LGA) (adjusted odds ratio [aOR], 7.9; 95% CI, 5.3-11.8). Women with type 1 diabetes were more likely to have had labour induced (aOR, 3.0; 95% CI, 2.0-4.5), a caesarean delivery (aOR, 4.6; 95% CI, 3.1-7.0), or a pre-term birth (aOR, 6.7; 95% CI, 4.5-10.0); their babies were more likely to have shoulder dystocia (aOR, 8.2; 95% CI, 3.6-18.7), hypoglycaemia (aOR, 10.3; 95% CI, 6.8-15.6), jaundice (aOR, 5.1; 95% CI, 3.3-7.7), respiratory distress (aOR, 2.5; 95% CI, 1.4-4.4) or to suffer perinatal death (aOR, 4.3; 95% CI, 1.9-9.9). In women with type 1 diabetes, greater obesity was associated with increased odds for an LGA baby or congenital malformation, and increased HbA1c levels were associated with pre-term birth and perinatal death.CONCLUSION: Women with type 1 diabetes, even when managed in a specialist setting, still experience adverse obstetric and neonatal outcomes. Poor glycaemic control is not wholly responsible for adverse outcomes, reinforcing the importance of other risk factors, such as obesity and weight gain.
Original languageEnglish
Pages (from-to)162-167
Number of pages5
JournalMedical Journal of Australia
Volume205
Issue number4
DOIs
Publication statusPublished - 15 Aug 2016

Cite this

@article{e78ca1e30b23412bb27836418a29c176,
title = "Contemporary type 1 diabetes pregnancy outcomes: Impact of obesity and glycaemic control",
abstract = "OBJECTIVE: To compare contemporary pregnancy outcomes in women with and without type 1 diabetes, and to examine the effects of obesity and glycaemic control on these outcomes.DESIGN AND SETTING: Historical cohort study in a specialist diabetes and maternity network in Victoria.PARTICIPANTS: All singleton births (at least 20 weeks' gestation), 2010-2013, were analysed: 107 pregnancies to women with type 1 diabetes and 27 075 pregnancies to women without diabetes. Women with type 2 diabetes or gestational diabetes were excluded.METHODS: Data were extracted from the Birthing Outcomes System database; associations between type 1 diabetes and pregnancy outcomes were analysed by multivariable regression.MAIN OUTCOME MEASURES: Mode of birth; maternal and neonatal outcomes.RESULTS: The mean body mass index was higher for women with type 1 diabetes than for women without diabetes (mean, 27.3 kg/m(2) [SD, 5.0] v 25.7 kg/m(2) [SD, 5.9]; P = 0.01); the median gestation period for their babies was shorter (median, 37.3 weeks [IQR, 34.6-38.1] v 39.4 weeks [IQR, 38.4-40.4]; P < 0.001) and they were more likely to be large for gestational age (LGA) (adjusted odds ratio [aOR], 7.9; 95{\%} CI, 5.3-11.8). Women with type 1 diabetes were more likely to have had labour induced (aOR, 3.0; 95{\%} CI, 2.0-4.5), a caesarean delivery (aOR, 4.6; 95{\%} CI, 3.1-7.0), or a pre-term birth (aOR, 6.7; 95{\%} CI, 4.5-10.0); their babies were more likely to have shoulder dystocia (aOR, 8.2; 95{\%} CI, 3.6-18.7), hypoglycaemia (aOR, 10.3; 95{\%} CI, 6.8-15.6), jaundice (aOR, 5.1; 95{\%} CI, 3.3-7.7), respiratory distress (aOR, 2.5; 95{\%} CI, 1.4-4.4) or to suffer perinatal death (aOR, 4.3; 95{\%} CI, 1.9-9.9). In women with type 1 diabetes, greater obesity was associated with increased odds for an LGA baby or congenital malformation, and increased HbA1c levels were associated with pre-term birth and perinatal death.CONCLUSION: Women with type 1 diabetes, even when managed in a specialist setting, still experience adverse obstetric and neonatal outcomes. Poor glycaemic control is not wholly responsible for adverse outcomes, reinforcing the importance of other risk factors, such as obesity and weight gain.",
author = "Abell, {Sally K} and Boyle, {Jacqueline A} and {de Courten}, Barbora and Michell Knight and Sanjeeva Ranasinha and John Regan and Georgia Soldatos and Wallace, {Euan M} and Sophia Zoungas and Teede, {Helena J}",
year = "2016",
month = "8",
day = "15",
doi = "10.5694/mja16.00443",
language = "English",
volume = "205",
pages = "162--167",
journal = "Medical Journal of Australia",
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Contemporary type 1 diabetes pregnancy outcomes : Impact of obesity and glycaemic control. / Abell, Sally K; Boyle, Jacqueline A; de Courten, Barbora; Knight, Michell; Ranasinha, Sanjeeva; Regan, John; Soldatos, Georgia; Wallace, Euan M; Zoungas, Sophia; Teede, Helena J.

In: Medical Journal of Australia, Vol. 205, No. 4, 15.08.2016, p. 162-167.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Contemporary type 1 diabetes pregnancy outcomes

T2 - Impact of obesity and glycaemic control

AU - Abell, Sally K

AU - Boyle, Jacqueline A

AU - de Courten, Barbora

AU - Knight, Michell

AU - Ranasinha, Sanjeeva

AU - Regan, John

AU - Soldatos, Georgia

AU - Wallace, Euan M

AU - Zoungas, Sophia

AU - Teede, Helena J

PY - 2016/8/15

Y1 - 2016/8/15

N2 - OBJECTIVE: To compare contemporary pregnancy outcomes in women with and without type 1 diabetes, and to examine the effects of obesity and glycaemic control on these outcomes.DESIGN AND SETTING: Historical cohort study in a specialist diabetes and maternity network in Victoria.PARTICIPANTS: All singleton births (at least 20 weeks' gestation), 2010-2013, were analysed: 107 pregnancies to women with type 1 diabetes and 27 075 pregnancies to women without diabetes. Women with type 2 diabetes or gestational diabetes were excluded.METHODS: Data were extracted from the Birthing Outcomes System database; associations between type 1 diabetes and pregnancy outcomes were analysed by multivariable regression.MAIN OUTCOME MEASURES: Mode of birth; maternal and neonatal outcomes.RESULTS: The mean body mass index was higher for women with type 1 diabetes than for women without diabetes (mean, 27.3 kg/m(2) [SD, 5.0] v 25.7 kg/m(2) [SD, 5.9]; P = 0.01); the median gestation period for their babies was shorter (median, 37.3 weeks [IQR, 34.6-38.1] v 39.4 weeks [IQR, 38.4-40.4]; P < 0.001) and they were more likely to be large for gestational age (LGA) (adjusted odds ratio [aOR], 7.9; 95% CI, 5.3-11.8). Women with type 1 diabetes were more likely to have had labour induced (aOR, 3.0; 95% CI, 2.0-4.5), a caesarean delivery (aOR, 4.6; 95% CI, 3.1-7.0), or a pre-term birth (aOR, 6.7; 95% CI, 4.5-10.0); their babies were more likely to have shoulder dystocia (aOR, 8.2; 95% CI, 3.6-18.7), hypoglycaemia (aOR, 10.3; 95% CI, 6.8-15.6), jaundice (aOR, 5.1; 95% CI, 3.3-7.7), respiratory distress (aOR, 2.5; 95% CI, 1.4-4.4) or to suffer perinatal death (aOR, 4.3; 95% CI, 1.9-9.9). In women with type 1 diabetes, greater obesity was associated with increased odds for an LGA baby or congenital malformation, and increased HbA1c levels were associated with pre-term birth and perinatal death.CONCLUSION: Women with type 1 diabetes, even when managed in a specialist setting, still experience adverse obstetric and neonatal outcomes. Poor glycaemic control is not wholly responsible for adverse outcomes, reinforcing the importance of other risk factors, such as obesity and weight gain.

AB - OBJECTIVE: To compare contemporary pregnancy outcomes in women with and without type 1 diabetes, and to examine the effects of obesity and glycaemic control on these outcomes.DESIGN AND SETTING: Historical cohort study in a specialist diabetes and maternity network in Victoria.PARTICIPANTS: All singleton births (at least 20 weeks' gestation), 2010-2013, were analysed: 107 pregnancies to women with type 1 diabetes and 27 075 pregnancies to women without diabetes. Women with type 2 diabetes or gestational diabetes were excluded.METHODS: Data were extracted from the Birthing Outcomes System database; associations between type 1 diabetes and pregnancy outcomes were analysed by multivariable regression.MAIN OUTCOME MEASURES: Mode of birth; maternal and neonatal outcomes.RESULTS: The mean body mass index was higher for women with type 1 diabetes than for women without diabetes (mean, 27.3 kg/m(2) [SD, 5.0] v 25.7 kg/m(2) [SD, 5.9]; P = 0.01); the median gestation period for their babies was shorter (median, 37.3 weeks [IQR, 34.6-38.1] v 39.4 weeks [IQR, 38.4-40.4]; P < 0.001) and they were more likely to be large for gestational age (LGA) (adjusted odds ratio [aOR], 7.9; 95% CI, 5.3-11.8). Women with type 1 diabetes were more likely to have had labour induced (aOR, 3.0; 95% CI, 2.0-4.5), a caesarean delivery (aOR, 4.6; 95% CI, 3.1-7.0), or a pre-term birth (aOR, 6.7; 95% CI, 4.5-10.0); their babies were more likely to have shoulder dystocia (aOR, 8.2; 95% CI, 3.6-18.7), hypoglycaemia (aOR, 10.3; 95% CI, 6.8-15.6), jaundice (aOR, 5.1; 95% CI, 3.3-7.7), respiratory distress (aOR, 2.5; 95% CI, 1.4-4.4) or to suffer perinatal death (aOR, 4.3; 95% CI, 1.9-9.9). In women with type 1 diabetes, greater obesity was associated with increased odds for an LGA baby or congenital malformation, and increased HbA1c levels were associated with pre-term birth and perinatal death.CONCLUSION: Women with type 1 diabetes, even when managed in a specialist setting, still experience adverse obstetric and neonatal outcomes. Poor glycaemic control is not wholly responsible for adverse outcomes, reinforcing the importance of other risk factors, such as obesity and weight gain.

U2 - 10.5694/mja16.00443

DO - 10.5694/mja16.00443

M3 - Article

VL - 205

SP - 162

EP - 167

JO - Medical Journal of Australia

JF - Medical Journal of Australia

SN - 0025-729X

IS - 4

ER -