Pregnancy Outcome in Type 2 Diabetes Mellitus: A Retrospective Analysis from the Netherlands

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Abstract
The Review of Diabetic Studies,2006,3,3,134-142.
Published:November 2006
Type:Original Article
Authors:
Author(s) affiliations:

Harold W. de Valk1, Nancy H.G. van Nieuwaal1 and Gerard H.A. Visser2

1Department of Internal Medicine, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands.

2Department of Perinatal Medicine and Gynecology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands.

Abstract:

Main Objectives: The objective was to describe pregestational history and the maternal, fetal and neonatal outcome in pregnancies in women with pre-gestational type 2 diabetes during the period between 1992 and 2006 from one center in the Netherlands. Methods: Patients attending the obstetric-diabetology outpatient clinic of a tertiary referral center were studied. This center also has a regular diabetes clinic and a community midwifery service. Patients were identified from the database. Maternal outcome (preeclampsia, pre-term delivery, Cæsarean section) and fetal and neonatal outcome (macrosomia, congenital malformations, perinatal mortality, neonatal hypoglycemia) were analyzed as well HbA1c levels, planning of pregnancy, gestational age at first antenatal visit and ethnic background. Results: Sixtysix singleton pregnancies from 48 women were analyzed. Their age was 34 ± 5 yr, the BMI 31.7 ± 7.4 and the median duration of diabetes was 3 yr. 52% were Caucasian and 35% were of Moroccan descent. 49% did not complete secondary school. Moroccan descent was associated with a lower educational level and a BMI comparable with the whole study group. The proportion of planned pregnancies was approximately 70%. The mean HbA1c in the first trimester was 6.4 ± 1.1% and the gestational age at first visit was 10 ± 5 wk, in one-quarter before 6 wk. The prevalences of variables related to maternal and neonatal outcome were as follows: spontaneous abortion 13.6%, pre-eclampsia 8.9%, preterm delivery 21.4%, spontaneous labor 25.0%, induced labor 48.2%, Cæsarean section 42.9%, macrosomia (≥90th percentile) 41.1%, severe hypoglycemia 41.5% and major congenital malformations 5.1%. Conclusion: Pregestational type 2 diabetes is associated with an increased incidence of adverse pregnancy outcome despite reasonable mean HbA1c level and despite a high frequency of planned pregnancies. Many women report relatively late. Improvement in the outcome requires more active peri-gestational specialist care and a tailored approach is required towards migrant communities.