Maternal Diabetes, Fetal Growth and Stillbirth Risk: A Population-Wide Retrospective Cohort Study From Victoria, Australia

Abstract

Objective: To determine the relationships between diabetes in pregnancy, birth weight, and stillbirth risk, using population-based data.

Research design and methods: All singleton births in Victoria, Australia, between 2009 and 2020 were linked with perinatal and diabetes data. For each diabetes subgroup (type 1, type 2, and gestational diabetes [diet-controlled, insulin-controlled]), we assessed the proportion of infants with a birth weight in <10th or >97th centile, the probability of stillbirth by birth weight centile, and stillbirth rate per 1,000 pregnancies across gestational age.

Results: Our study cohort of 860,042 included 100,856 pregnancies (11.7%) complicated by diabetes in pregnancy. Compared with no diabetes, women with diabetes in pregnancy gave birth earlier (median gestation 38.7 weeks vs. 39.4) and had more iatrogenic births (65% vs. 44%). Gestational diabetes was associated with a lower overall risk of stillbirth compared with no diabetes (diet-controlled: relative risk [RR] 0.75 [95% CI 0.64-0.89]; insulin-controlled: RR 0.37 [95% CI 0.25-0.50]). Compared with no diabetes, preexisting diabetes was associated with an increased risk of stillbirth (RR 2.68 [95% CI 2.01-3.56]), with this trend persisting across all gestational ages and birth weights. This was particularly observed among infants in the >97th centile (type 1 diabetes: RR 3.96 [95% CI 1.23-12.76]; type 2 diabetes: RR 4.02 [95% CI 1.71-9.47]).

Conclusions: In our cohort, gestational diabetes was associated with a lower stillbirth risk compared with no diabetes, which potentially can be explained by increased monitoring and earlier iatrogenic delivery. Preexisting diabetes was associated with a higher overall risk of stillbirth, with macrosomic fetuses in the >97th centile representing a particularly high-risk group requiring close monitoring.