UK study: Subpar glycemic control associated with poor pregnancy outcomes

British women who have poorer glycemic control before and during pregnancy have poorer outcomes and less-healthy babies. That's the take home message from CEMACH, the Confidential Enquiry into Maternal and Child Health, a year-long survey of pregnant women with type 1 and type 2 diabetes across the United Kingdom.

"Women with diabetes continue to have higher perinatal mortality and higher congenital abnormality rates than the general population," said study director Jo Modder, MD, consultant to the National Health Service Foundation, London.

The survey covered 222 maternity units in England, Wales and Northern Ireland. The data set included all women at any stage of pregnancy with pre-existing diabetes, a total of 3808 pregnancies, between March 2002 and February 2003. Researchers identified 222 poor pregnancy outcomes, 127 infants with congenital abnormalities and 95 who died at 20 weeks or younger. The study included chart reviews and assessments of care by health care professionals, but all data were anonymized. Neither women nor the care givers were identified or interviewed.

In the study group, 27% of women (1041) had type 1 diabetes and 2767 had type 2. Type 2 women were slightly older when they had their babies, 33.5 years, versus 30 years for type 1 women. However, type 1 women had suffered with diabetes longer, 13 years, versus 3 years for type 2 women.

Almost half of the type 2 women, 45%, came from the most-deprived socioeconomic groups. Type 1 women were distributed more evenly across the socioeconomic spectrum.

Stillbirths: nearly 5 times the risk
Babies born from women with diabetes had significantly poorer outcomes than matched case control mother-infant pairs. Diabetic women were almost five times more likely to have a stillborn child, twice as likely to have a child with a major congenital abnormality, and more than twice as likely to have a child who died during the perinatal period.

"Women with poor outcomes had poor glycemic control all the way through pregnancy," Dr. Modder said. "Good outcomes were just as strongly associated with good glycemic control."

Medical care for women with diabetes was also less than optimal. Fewer than 60% of women in the survey had a retinal exam and a renal function test in the year preceding pregnancy. Health providers generally failed to offer preconception advice, did not prescribe or suggest folic acid supplements, and provided poor screening/management of preexisting diabetes.

"We don't seem to be having some very important discussions before or during pregnancy with our women," Dr. Modder said. "It is clear that we need to do a better job of treating all women, not just pregnant women."