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Pre-existing diabetes, maternal glycated haemoglobin, and the risks of fetal and infant death: a population-based study

Lookup NU author(s): Peter Tennant, Dr Svetlana Glinyanaya, Professor Rudy Bilous, Professor Judith Rankin, Dr Ruth Bell

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Abstract

Aims: Pre-existing diabetes is associated with an increased risk of stillbirth but few studies have excluded the effect of congenital anomalies. This study used data from a long-standing population-based survey of women with pre-existing diabetes to investigate the risks of fetal and infant death and quantify the contribution of glycaemic control. Methods: All normally-formed singleton offspring occurring in women with pre-existing diabetes (n=1206 with type 1 diabetes and n=342 with type 2 diabetes) in the North of England during 1996-2008 were identified from the Northern Diabetes in Pregnancy Survey. Relative risks (RRs) of fetal death (≥20 weeks' gestation) and infant death were estimated by comparison with population data from the Northern Perinatal Morbidity and Mortality Survey. Predictors of fetal and infant death in women with pre-existing diabetes were examined by logistic regression. Results: The prevalence of fetal death in women with diabetes was over four times greater than among those without [RR=4.56 (95% confidence interval, CI: 3.42, 6.07) p<0.0001], while for infant death it was nearly doubled [RR=1.86 (95% CI: 1.00, 3.46) p=0.046]. There was no difference in the prevalence of fetal death (p=0.51) or infant death (p=0.70) between women with type 1 diabetes and women with type 2 diabetes. There was no evidence that the RR of fetal and infant death had changed over time (p=0.95). Increasing peri-conception HbA1c above 49mmol/mol (6.6%) [adjusted odds ratio, aOR=1.02 (95% CI: 1.00, 1.04) p=0.01], pre-pregnancy retinopathy [aOR=2.05 (95% CI: 1.04, 4.05) p=0.04] and lack of pre-pregnancy folic acid consumption [aOR=2.52 (95% CI: 1.12, 5.65) p=0.03] were all independently associated with increased odds of fetal and infant death. Conclusions: Pre-existing diabetes is associated with a substantially increased risk of fetal and infant death in normally-formed offspring, the effect of which is largely moderated by glycaemic control.


Publication metadata

Author(s): Tennant PWG, Glinianaia SV, Bilous RW, Rankin J, Bell R

Publication type: Article

Publication status: Published

Journal: Diabetologia

Year: 2014

Volume: 57

Issue: 2

Pages: 285-294

Print publication date: 01/02/2014

Online publication date: 01/02/2014

Acceptance date: 28/10/2013

ISSN (print): 0012-186X

ISSN (electronic): 1432-0428

Publisher: Springer

URL: http://dx.doi.org/10.1007/s00125-013-3108-5

DOI: 10.1007/s00125-013-3108-5

Notes: epub:29/11/2013


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