infant mortality

Type 1 and type 2 diabetes in pregnancy increase risk of losing baby

by Barbara Hewitt on January 15, 2018

Both type 1 and type 2 diabetes can trigger complications for pregnant women leading to infant death, either in the womb or shortly after birth, new research has found.

The 15-year study of over 800,000 women in Scotland found that pregnant women with diabetes are up to five times more likely to lose their babies and they are also more likely to need a caesarean.

(Ivanko80/Bigstock.com

Sharon Mackin, clinical research fellow and the lead author of the study from the University of Glasgow, pointed out that while diabetes in pregnancy remains relatively uncommon, affecting one in every 178 births, because of the prevalence of type 2 in particular, which is linked to obesity, complications in pregnancy were increasing.

Of the 813,883 births there were 104 deaths soon after birth in children of mothers with diabetes. There were 65 among type 1 sufferers, a rate 4.2 times higher than the general Scottish population, and 39 among type 2 patients, which was a rate 3.1 times higher.

The rate of stillbirths was four times higher among type 1 patients and five times higher among type 2, according to the study which covered all pregnancies in Scotland over the 15 year time period thus avoiding selection bias.

Scientists who conducted the large scale study believe that part of the issue could be that diabetic mothers are more likely to have larger babies, increasing the strain of pregnancy for mother and child.

A high birthweight or large for gestational age (LGA) is defined as an infant whose weight puts them in the heaviest 10% of new borns, and being so large carries with it an increased risk of complications during pregnancy.

The study found that more than half of all babies born to mothers with type 1 diabetes were defined as LGA, while 38% of mothers with type 2 diabetes had an LGA infant. These rates are 4.8 and 3.7 times higher respectively than the wider population, and while the trend in mothers with type 2 diabetes shows a long term fall in the proportion of LGA infants, it is becoming more common for mothers with type 1 diabetes.

The exact reasons for these changes are not fully understood. ‘It would be of interest to be able to account for other maternal factors such as BMI and gestational weight gain which may impact infant growth and placental function,’ the study report says.

‘Birth weight, prematurity, operative delivery and perinatal mortality represent key outcome measures in the management of pregnancy complicated by diabetes. It is a concern then, that stillbirth and perinatal mortality rates appear stable over time in our population while, at least for type 1 diabetes, birth weight is increasing,’ it explains.

Pregnancy for women with diabetes remains high risk and much remains to be understood regarding causes and effective interventions for adverse outcomes. There is a major unmet need to improve perinatal outcomes for women with diabetes treated during pregnancy. Novel approaches and technologies will be needed to address this,’ it concludes.

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