Multisystem Morbidity and Mortality in Offspring of Women With Type 1 Diabetes (The EPICOM Study): A Register-Based Prospective Cohort Study (original) (raw)
Related papers
Diabetologia, 2018
The aims of this study were to examine long-term mortality and morbidity rates in mothers with type 1 diabetes, both overall and according to the level of albuminuria prior to pregnancy, the presence of hypertension, pre-eclampsia and periconceptional HbA. This study was a part of the EPICOM (Environmental Versus Genetic and Epigenetic Influences on Growth, Metabolism and Cognitive Function in Offspring of Mothers with Type 1 Diabetes) study, which is a prospective follow-up study focusing on pregnancies complicated by maternal type 1 diabetes. We carried out a nationwide combined clinical and register-based cohort study of mortality rates and hospital admissions in mothers with diabetes (n = 986) who gave birth between 1992 and 2000. Control mothers (n = 91,441) were women from the background population, matched according to age and year of childbirth. Age at follow-up was 32-66 years. Mortality rate was increased threefold in mothers with diabetes compared with control mothers (HR...
Perinatal and infant mortality in term and preterm births among women with type 1 diabetes
Diabetologia, 2011
Aims/hypothesis The aim of this study was to estimate the risks of adverse birth outcomes such as stillbirth, infant death, preterm birth and pre-eclampsia in women with type 1 diabetes, compared with the background population. We further aimed to explore the risks of adverse birth outcomes in preterm and term deliveries separately. Methods By linkage of two nationwide registries, the Medical Birth Registry of Norway and the Norwegian Childhood Diabetes Registry, we identified 1,307 births among women with pregestational type 1 diabetes registered in the Diabetes Registry, and 1,161,092 births in the background population during the period 1985-2004. The ORs with 95% CIs for adverse outcome among women with type 1 diabetes vs the background population were estimated using logistic regression. Results The OR for stillbirth (≥22 weeks of gestation) was 3.6 (95% CI 2.5, 5.3), and for perinatal death (stillbirth or death in the first week of life) it was 2.9 (95% CI 2.0, 4.1). The OR for infant death (first year of life) was 1.9 (95% CI 1.1, 3.2). For preterm birth (< 37 weeks of gestation) and pre-eclampsia the ORs were 4.9 (95% CI 4.3, 5.5) and 6.3 Electronic supplementary material The online version of this article
Diabetologia, 2012
Aims/hypothesis To investigate clinical and sociodemographic predictors of birthweight in singletons born to women with type 1 or type 2 diabetes. Methods Normally formed singleton live births and intrapartum stillbirths, born to women with pre-conception diabetes during 1996-2008, were identified from the population-based Northern Diabetes in Pregnancy Survey (n01,505). Associations between potential predictors and birthweight were analysed by multiple regression. Results Potentially modifiable independent predictors of increase in birthweight were pre-pregnancy care (adjusted regression coefficient [b]087.1 g; 95% CI 12.9, 161.3), increasing third-trimester HbA 1c ≤7% (53 mmol/mol) (b0310.5 g per 1% [11 mmol/mol]; 95% CI 246.3, 374.7) and increasing maternal BMI (b09.5 g per 1 kg/m 2 ; 95% CI 3.5, 15.5). Smoking during pregnancy (b0−145.1 g; 95% CI −231.4, −58.8), later gestation at first antenatal visit (b0−15.0 g; 95% CI −26.9, −3.0) and higher peri-conception HbA 1c (b0−48.2 g; 95% CI −68.8, −27.6) were independently associated with birthweight reduction. Pre-pregnancy nephropathy (b 0−282.7 g; 95% CI −461.8, −103.6) and retinopathy (b0−175.5 g; 95% CI −269.9, −81.0) were independent non-modifiable predictors of reduced birthweight, while greater maternal height was a non-modifiable predictor of increasing birthweight (b017.8 g; 95% CI 12.3, 23.2). Other predictors of birthweight increase were male sex, multiparity and increasing gestational age at delivery. Type or duration of diabetes, socioeconomic status and ethnicity were not associated with continuous birthweight. Conclusions/interpretation Poor glycaemic control before and throughout pregnancy is associated with abnormal fetal growth, with increasing peri-conception HbA 1c predicting weight reduction and increasing third-trimester HbA 1c predicting increased birthweight. Women with microvascular complications of diabetes may require increased surveillance to detect fetal growth restriction.
Obstetric and Perinatal Outcomes in Women with Type 1 Diabetes Mellitus
Romanian Journal of Diabetes Nutrition and Metabolic Diseases, 2013
Background and aims: Pregnancy in women with type 1 diabetes mellitus (T1DM) is associated with increased risk of maternal and fetal complications. The aim of this study was to examine and to compare pregnancy outcomes between women with T1DM and a control group of non diabetic women. Material and method: The present study included all pregnancies in T1DM women followed at Diabetes Clinic, Emergency County Clinical Hospital, Timişoara, from 1990 to 2010. Results: We found a relative risk of spontaneous abortions of 1.85 (95%CI 1.01-3.39; p=0.05) and a relative risk of major congenital malformations of 4.32 (95%CI 1.55-12; p=0.005) in T1DM pregnancies compared to the control group. We also observed that the rate of stillbirth was more frequent in type 1 diabetic pregnancies (p=0.02). The offspring of T1DM women were more likely to be delivered preterm (32%) compared with the control group (9.5%). The relative risk of preterm delivery was 3.38 higher (95%CI 2.93-5.6; p<0.0001) in T1DM pregnancies compared with non diabetic mothers. There was a statistically significant difference in the proportion of macrosomic offspring between T1DM (17.3%) and non diabetic mothers (6.5%) Conclusions: The present study demonstrated that pregnancy outcome and perinatal complications are still high in T1DM pregnancies.
Diabetes type 1 and pregnancy outcome at University Hospital Center Split – a retrospective study
Medicina Fluminensis, 2021
Aim: To evaluate the prevalence, assessment, and perinatal outcome of pregnancies complicated with diabetes mellitus type 1 (DM type 1) at a tertiary perinatal center in the town of Split, Dalmatia County. Materials and methods: The investigation was designed as a retrospective cohort study. All pregnant women with DM type 1 that were supervised and gave birth at Clinical Department of Obstetrics and Gynecology, Split University Hospital Center during a 7-year period (2009-2015), including those diagnosed in 2015 and having delivered in 2016, were included in the study group. Data were collected by the census method from legal protocol books. Control group included DM type 1-free pregnancies entered in the same protocol books just following a particular study woman, if meeting all inclusion and exclusion criteria. Results: There were 70 DM type 1 pregnancies, accounting for 0.2% of all deliveries. DM type 1 group newborns were statistically heavier (3650±605 vs. 3428±591g; p=0.031),...
Outcomes in Type 1 Diabetic Pregnancies: A nationwide, population-based study
Diabetes Care, 2004
OBJECTIVE—The aim of this study was to compare pregnancy outcomes in type 1 diabetic pregnancies with the background population. RESEARCH DESIGN AND METHODS—This nationwide prospective multicenter study took place in eight Danish centers treating pregnant women with type 1 diabetes during 1993–1999. A total of 990 women with 1,218 pregnancies and delivery after 24 weeks (n = 1,215) or early termination due to severe congenital malformations (n = 3) were included. Data were collected prospectively by one to three caregivers in each center and reported to a central registry. RESULTS—The perinatal mortality rate was 3.1% in type 1 diabetic pregnancies compared with 0.75% in the background population (RR 4.1 [95% CI 2.9–5.6]), and the stillbirth rate was 2.1% compared with 0.45 (4.7 [3.2–7.0]). The congenital malformation rate was 5.0% in the study population and 2.8% (1.7 [1.3–2.2]) in the background population. Six of the perinatal deaths (16%) were related to congenital malformations...
Diabetes Care, 1994
OBJECTIVE To identify possible in utero risk factors in children who develop type I diabetes and to determine the risk of development of type I diabetes in the children of women with gestational diabetes. RESEARCH DESIGN AND METHODS All known children with type I diabetes born at the Mercy Hospital for Women whose mothers had glucose tolerance tests (GTTs) performed during pregnancy were identified. The results of the mothers' GTTs were compared with those of the hospital population, as were their obstetric complications. RESULTS We identified 38 children with type I diabetes born at this hospital whose mothers had GTTs performed during pregnancy. Only one of these mothers had gestational diabetes, compared with 5.6% in the overall hospital population (adjusted odds ratio 0.69, 95% confidence interval 0.12–3.84, P = 0.99). There were no differences in the blood glucose levels between the mothers of the children who developed diabetes and the general hospital population. The birt...
Different Risks of Complications of Pregnancy in Women with Type 1 Diabetes
2021
Introduction: Type 1 diabetes holding pregnant women are also associated with a highly increased risk of congenital malformations, neonatal morbidity, and obstetric complications. These highly adverse results are related to preconceptional care typically related to the glycaemic control level. Aims and objectives: The basic aim of the study is to analyze different Risks of Complications of Pregnancy in Women with Type 1 Diabetes. Material and methods: This cross sectional study was conducted in Islamic International Medical College during March 2020 to August 2020. Record gathered from 118 hospitals with the total number of 364 women stated for the study coordinator. As per database record, 11% (41 women) were excluded due to initial trimester spontaneous abortion as well as type 2 diabetes diagnosed in 16; 4% and follow up loss 2; 1%. We also stated the assessment of 323 pregnancies and all respondents gave written apprised consent. Entitled women completed questionnaires at inclusion (at the end of the initial trimester and around gestation of ten weeks) but during the trimester three (which is almost around 34 weeks). Results: Maternal outcomes in pregnant women with type 1 diabetes and those without the disease were evaluated in this study. No maternal mortality occurred within 30 days of delivery in 630 pregnancies with type 1 diabetes. However, pregnant women with type 1 diabetes were usually at a much higher risk of developing adverse maternal events during their pregnancy than women without type 1 diabetes, even after adjusting for age and infant sex or age, infant sex, place of residence, income level, occupation, calendar year, and Charlson comorbidity index. The risks of preeclampsia, eclampsia and cesarean delivery, increased in the type 1 diabetes cohort. Conclusion: It is concluded type 1 diabetes remains a significant disease threatening pregnant women and their offspring. Clinicians should be aware of this clinical situation.
HbA1c as a predictor of diabetes after gestational diabetes mellitus
Primary Care Diabetes, 2017
We wanted to investigate third-trimester HbA1c as a predictor of diabetes after gestational diabetes mellitus (GDM). Methods: Women with GDM were followed up prospectively for five years from pregnancy to detect the development of diabetes. The ability of HbA1c to predict diabetes was evaluated with receiver-operating characteristic (ROC) curves and logistic regression analysis. Results: By five years, 73 of 196 women had been diagnosed with diabetes. An optimal cutoff point for HbA1c of 36 mmol/mol (5.4%) could predict diabetes with 45% sensitivity and 92% specificity. For HbA1c ≥39 mmol/mol (≥5.7%), sensitivity, specificity, and positive predictive value were 30%, 97%, and 91%, respectively. In logistic regression analysis, adjusting for the diagnostic glucose concentration during pregnancy, HbA1c levels in the upper quartile (≥36 mmol/mol) were associated with a 5.5-fold increased risk of diabetes. Conclusion: Third-trimester HbA1c levels in the pre-diabetes range revealed women with post-partum diabetes with high specificity and high positive predictive value. HbA1c testing could be used as a strategy to select high-risk women for lifestyle interventions aimed at prevention of diabetes starting during pregnancy. The results should encourage further validation in other populations using new diagnostic criteria for GDM.
Pregnancy and neonatal outcomes in women with type 1 diabetes mellitus
Bratislavské lekárske listy, 2017
Bratislava from January 1st 2009 to December 31th 2015 were included to the study. RESULTS: Out of 118 diabetic mothers, 46.6 % had vasculopathy and 53. 4 % were without microvascular complications. In the vasculopathy group, signifi cantly higher incidence rates of preeclampsia (49. 1 versus 19.1 %; p = 0.002) and caesarean section (89.1 versus 68.3 %; p = 0.017) were found. Neonatal morbidity and mortality rates were higher in vasculopathy group (but not statistically signifi cantly). Preparation for pregnancy improves perinatal and neonatal results. Nevertheless, this preparation in our study group was received only in 9.3 %. Perinatal mortality was 25.4 per 1,000 total births. CONCLUSION: For pregnancy of diabetic women to become possible a qualifi ed management must be provided. Good outcomes for both women and newborns are real when preparation for pregnancy and metabolic control before and during whole pregnancy are at adequate level