Higher risk of stillbirths and infant deaths' with pre-existing diabetes


Higher risk of stillbirths and infant deaths' with pre-existing diabetes

New research suggests that pregnant women who have pre-existing diabetes are significantly more likely to experience stillbirths or death of their infant after birth. This is according to a study published in the journal Diabetologia.

Investigators from Newcastle University in the UK, the South Tees NHS Trust and Public Health England say that previous research has analyzed the association between women with pre-existing diabetes and deaths of unborn fetuses and young infants.

But they point out that their study excludes diseases already existing from birth (congenital anomalies).

To reach their findings, the researchers analyzed data from the Northern Diabetes in Pregnancy Survey.

The data included pregnant women with pre-existing diabetes and all their normally formed singleton infants. Type 1 diabetes was present in 1,206 women, while 342 had type 2 diabetes.

By comparing population data from the Northern Perinatal Morbidity and Mortality Survey, the investigators estimated the relative risk of stillbirth - defined as death of a fetus at or after 20 weeks' gestation - and infant death - defined as death in the first year of an infant's life.

Reduced hemoglobin levels 'may have reduced prevalence'

From their analysis, the researchers found that women who had pre-existing diabetes were 4.56 times more likely to suffer stillbirth and 1.86 times more likely to have their infants die after birth, compared with women who did not have pre-existing diabetes.

Women with glycated hemoglobin (a measure of blood sugar) above 6.6%, pre-pregnancy diabetic retinopathy and low folic acid supplementation were at higher risk of suffering fetal or infant death.

Researchers say that pregnant women with pre-existing diabetes are more than four times more likely to suffer stillbirth and almost twice as likely to have infant death after birth, compared with women without the condition.

When looking at the prevalence of fetal death, women with pre-existing diabetes showed a prevalence rate of 3%, compared with 0.7% in women without diabetes.

The prevalence of infant death was 0.7% in women with pre-existing diabetes, compared with 0.4% in women without the condition.

Furthermore, the investigators point out that glycated hemoglobin levels in the pregnant women studied were an average of 7.8%.

They note that this is higher than the 6.1% target set by England's National Institute for Health and Care Excellence (NICE), and also higher than the American Diabetes Association's recommended target of 7%.

The researchers estimate that if the pregnant women in the study had either recommended glycated hemoglobin levels, the prevalence of fetal or infant death may have reduced by 40%.

The investigators note they found no differences between the risks of fetal/and or fetal death in women who had type 1 diabetes, compared with those who had type 2 diabetes.

Commenting on their findings, the study authors say:

It's disappointing to see so little improvement because, with the right care, most women with diabetes can - and will - have a healthy baby.

Stillbirths and infant deaths are thankfully not common, but they could be even less common if all women with diabetes can be helped to achieve the best possible control of their blood glucose levels."

Recommendations to reduce risk

The investigators say one way that women with pre-existing diabetes could reduce the risk of stillbirth or infant death could be to take folic acid supplements.

"We already know that folic acid reduces the risk of certain congenital anomalies, such as spina bifida or cleft lip, which is why women with diabetes are advised to take high dose supplements of 5 milligrams daily," they say.

"Our results suggest this simple action may also help to reduce the risk of stillbirth or infant death even in babies without these conditions."

They note that folic acid supplements should be taken a minimum of 3 months before conceiving.

Additionally, the study authors point out that women with high blood glucose due to pre-existing diabetes who are planning a pregnancy should seek advice as early as possible from their doctor, as even a small reduction in blood glucose levels is likely to benefit the baby.

Dr. Ruth Bell, of Newcastle University and one of the study authors, told Medical-Diag.com:

It is important that all women with diabetes are aware of the implications of pregnancy and the steps they can take to reduce any risks.

We need to understand better how to talk to women at the right time about these risks so that they know what to do if they are thinking about pregnancy."

Medical-Diag.com recently reported on the development of new guidelines for diabetes testing in pregnant women.

Maternal death: a century of getting it wrong | Basky Thilaganathan | TEDxWandsworth (Video Medical And Professional 2020).

Section Issues On Medicine: Women health