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. 2023 Sep 7;52(1):30-40.
doi: 10.1515/jpm-2023-0183. Print 2024 Jan 29.

Maternal and neonatal complications in pregnancies with and without pre-gestational diabetes mellitus

Rebecca Karkia  1   2 , Tara Giacchino  2   3 , Helen Watson  1 , Andrew Gough  4 , Ghada Ramadan  5 , Ranjit Akolekar  2   3
Affiliations

Maternal and neonatal complications in pregnancies with and without pre-gestational diabetes mellitus

Rebecca Karkia et al. J Perinat Med. .

Abstract

Objectives: To compare pregnancy complications in pregnancies with and without pre-gestational diabetes mellitus (DM) managed in a multidisciplinary high-risk diabetes antenatal clinic.

Methods: This screening cohort study was undertaken at a large maternity unit in the United Kingdom between January 2010 and December 2022. We included singleton pregnancies that booked at our unit at 11-13 weeks' gestation. Univariate and multivariate logistic regression analysis was carried out to determine risks of complications in pregnancies with type 1 and type 2 DM after adjusting for maternal and pregnancy characteristics. Effect sizes were expressed as absolute risks (AR) and odds ratio (OR) (95 % confidence intervals [CI]).

Results: The study population included 53,649 singleton pregnancies, including 509 (1.0 %) with pre-existing DM and 49,122 (99.0 %) without diabetes. Multivariate logistic regression analysis demonstrated that there was a significant contribution from pre-existing DM in prediction of adverse outcomes, including antenatal complications such as fetal defects, stillbirth, preterm delivery, polyhydramnios, preeclampsia and delivery of large for gestational age (LGA) neonates; intrapartum complications such as caesarean delivery (CS) and post-partum haemorrhage; and neonatal complications including admission to neonatal intensive care unit, hypoglycaemia, jaundice and hypoxic ischaemic encephalopathy (HIE). In particular, there was a 5-fold increased risk of stillbirth and HIE.

Conclusions: The maternal and neonatal complications in pregnancies with pre-existing DM are significantly increased compared to those without DM despite a decade of intensive multidisciplinary antenatal care. Further research is required to investigate strategies and interventions to prevent morbidity and mortality in pregnancies with pre-gestational DM.

Keywords: adverse pregnancy outcomes; diabetes mellitus; insulin-dependent diabetes; pre-gestational diabetes mellitus.

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