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. 2025 Nov 1;48(11):1896-1903.
doi: 10.2337/dc25-0833.

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

Hannah G Gordon  1   2 , Alexis Shub  1   2 , Susan P Walker  1   2 , Richard J Hiscock  1   2 , Jessica Atkinson  1   2 , Stephen Tong  1   2 , Roxanne M Hastie  1   2 , Anthea C Lindquist  1   2 , Natasha L Pritchard  1   2
Affiliations

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

Hannah G Gordon et al. Diabetes Care. .

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.

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Conflict of interest statement

Duality of Interest. No potential conflicts of interest relevant to this article were reported.

Figures

None
Graphical abstract
Figure 1
Figure 1
Bar charts of Hadlock birth weight centiles. A: All singleton births in Victoria, Australia, 2009–2021. B: Infants unexposed to maternal diabetes. C: Infants exposed to gestational diabetes (diet). D: Infants exposed to gestational diabetes (insulin). E: Infants exposed to type 1 diabetes. F: Infants exposed to type 2 diabetes.
Figure 2
Figure 2
Predicted probability of stillbirth, adjusted for maternal BMI and fetal sex, by birth weight centile. *There were no stillbirths among women with type 1 diabetes with infants born in the <10th centile (n = 26). The predicted probability of stillbirth in the <10th centile was extrapolated in this cohort based on the probabilities observed across other centiles.
Figure 3
Figure 3
Stillbirth rate per 1,000 ongoing pregnancies by gestation by diabetes status. *Upper CI 15.92 at 40 weeks’ gestation; y-axis truncated to enhance readability. No rate was included at 41 weeks’ gestation because there were no stillbirths in this cohort, with only 82 ongoing pregnancies.
See this image and copyright information in PMC

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