Predictors for pregnancy outcomes in Romanian women with Type 1 Diabetes Mellitus: a prospective study

Diabetology & Metabolic Syndrome

Marius Craina³  Razvan Nitu³  Dana Stoian³  Alin Albai²  Romulus Timar²  Bogdan Timar¹ 

[1] Department III – Functional Sciences, “Victor Babes”, University of Medicine and Pharmacy, Timisoara, Romania;Department VII – Internal Medicine, “Victor Babes”, University of Medicine and Pharmacy, Timisoara, Romania;Department XII – Obstetrics and Gynecology, “Victor Babes”, University of Medicine and Pharmacy, Timisoara, Romania

关键词: Glycemic control;    Type 1 diabetes mellitus;    Pregnancy outcomes;   

Others  :  1138287
DOI  :  10.1186/1758-5996-6-125

 received in 2014-10-05, accepted in 2014-11-17,  发布年份 2014

【 摘 要 】

Background

Type 1 diabetes mellitus in pregnant women is associated with an increased risk of congenital malformations, obstetric complications, neonatal morbidity, and mortality. Our aim was to evaluate which factors from the first trimester of pregnancy have a significant impact on the pregnancy outcomes of women with type 1 diabetes.

Methods

We included 94 pregnant women with type 1 diabetes in this study. In these patients, we analyzed the influence of several diabetes-related parameters on the pregnancy outcome. We compared the parameters between two cohorts: those with successful pregnancies and those with adverse pregnancy outcomes, defined as spontaneous abortion or congenital malformations. The influence of several factors on the pregnancy outcome was assessed using multivariate and univariate logistic regressions.

Results

The prevalence of adverse pregnancy outcomes was 28.7%, and was associated with poorer glycemic control (p <0.001), lower frequency of daily self-monitoring tests (p <0.001), smoking status (p <0.001), alcohol consumption (p <0.001), increased prevalence of chronic complications of diabetes, and the presence of ketosis. However, the adverse outcomes were not significantly associated with age, duration of diabetes, presence of thyroid disease, or body mass index. Furthermore, planned pregnancy was found to be a significant protective factor (odds ratio, 0.15; p <0.001).

Conclusion

These results indicate that by carefully planning the pregnancy, ensuring optimal glycemic control, and eliminating habitual risk factors, the fetal risk in pregnancies among women with type 1 diabetes may decrease to a value similar to that noted in women without diabetes.

【 授权许可】

   
2014 Timar et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Garner P: Type 1 diabetes mellitus and pregnancy. Lancet 1995, 346:157-161.
• [2]Reece EA, Gabrielli S, Abdalla M: The prevention of diabetes associated birth defects. Semin Perinatol 1988, 12:292-301.
• [3]Hemachandra A, Ellis D, Lloyd CE, Orchard TJ: The influence of pregnancy on IDDM complications. Diabetes Care 1995, 18:950-954.
• [4]Ringholm L, Pedersen-Bjergaard U, Thorsteinsson B, Damm P, Mathiesen ER: Hypoglycemia during pregnancy in women withy Type 1 diabetes. Diabet Med 2012, 29:556-566.
• [5]Abourawi F: Diabetes mellitus and pregnancy. Libyan J Med 2006, 1:28-41.
• [6]García-Patterson A, Gich I, Amini SB, Catalano PM, de Levia A, Corcoy R: Insulin requirements throughout pregnancy in women with type 1 diabetes mellitus: three changes of direction. Diabetologia 2010, 53:446-451.
• [7]Bergrem H, Kalo I, Babic D: Diabetes care in Europe: The St. Vincent Declaration coming of age? Diabetes Nutr Metab 1996, 9:330-336.
• [8]Colstrup M, Mathiesen ER, Damm P, Jensen DM, Ringholm L: Pregnancy in women with type 1 diabetes: Have the goals of St. Vincent declaration been met concerning foetal and neonatal complications? J Matern Fetal Neonatal Med 2013, 26:1682-1686.
• [9]Feldman EL, Stevens MJ: Clinical testing in diabetic peripheral neuropathy. Can J Neurol Sci 1994, 21:S3-S7.
• [10]Bush K, Kivlahan DR, McDonell MB: The AUDIT alcohol consumption questions (AUDIT-C) – An effective brief screening test for problem drinking. Arch Intern Med 1998, 158:1789-1795.
• [11]Kenneth J, Rothman Sander G: Modern Epidemiology. Philadelphia: Lippincott-Raven Publishers; 1998.
• [12]Dolk H, Loane M, Garne E: The prevalence of congenital anomalies in Europe. Adv Exp Med Biol 2010, 686:349-364.
• [13]Macintosh MC, Fleming KM, Bailey JA, Doyle P, Modder J, Acolet D, Golightly S, Miller A: Perinatal mortality and congenital anomalies in babies of women with type 1 or type 2 diabetes in England, Wales, and Northern Ireland: population based study. Br Med J 2006, 333:177.
• [14]Jensen DM, Damm P, Moelsted-Pedersen L, Ovesen P, Westergaard JG, Moeller M, Beck-Nielsen H: Outcomes in type 1 diabetic pregnancies: a nationwide, population-based study. Diabetes Care 2004, 27:2819-2823.
• [15]Evers IM, de Valk HW, Visser GH: Risk of complications of pregnancy in women with type 1 diabetes: nationwide prospective study in the Netherlands. Br Med J 2004, 328:915.
• [16]Lapolla A, Dalfra MG, Di Cianni G, Bonomo M, Parretti E, Mello G, Scientific Committee of the GISOGD Group: A multicenter Italian study on pregnancy outcome in women with diabetes. Nutr Metab Cardiovasc Dis 2008, 18:291-297.
• [17]Cyganek K, Hebda-Szydlo A, Skupien J, Katra B, Janas I, Borodako A, Kaim I, Klupa T, Reron A, Malecki MT: Glycemic control and pregnancy outcomes in women with type 2 diabetes from Poland. The impact of pregnancy planning and a comparison with type 1 diabetes subjects. Endocrine 2011, 40:243-249.
• [18]Sapiano K, Savona-Ventura C, Calleja-Agius J, Serracino-Inglott A, Azzopardi LM: Attitudes towards preconception care in Maltese women with type 1 diabetes mellitus. Gynecol Endocrinol 2012, 28:1006-1009.
• [19]Ringholm L, Mathiesen ER, Kelstrup L, Damm P: Managing type 1 diabetes mellitus in pregnancy–from planning to breastfeeding. Nat Rev Endocrinol 2012, 8:659-667.
• [20]Achong N, Callaway L, D’Emden M, McIntyre HD, Lust K, Barrett HL: Insulin requirements in late pregnancy in women with type 1 diabetes mellitus: a retrospective review. Diabetes Res Clin Pract 2012, 98:414-421.
• [21]Callesen NF, Ringholm L, Stage E, Damm P, Mathiesen ER: Insulin requirements in type 1 diabetic pregnancy: do twin pregnant women require twice as much insulin as singleton pregnant women? Diabetes Care 2012, 35:1246-1248.
• [22]Flemming K, Graham H, Heirs M, Fox D, Sowden A: Smoking in pregnancy: a systematic review of qualitative research of women who commence pregnancy as smokers. J Adv Nurs 2013, 69:1023-1036.
• [23]Pruett D, Waterman EH, Caughey AB: Fetal alcohol exposure: consequences, diagnosis, and treatment. Obstet Gynecol Surv 2013, 68:62-69.
• [24]Persson M, Pasupathy D, Hanson U, Westgren M, Norman M: Pre-pregnancy body mass index and the risk of adverse outcome in type 1 diabetic pregnancies: a population-based cohort study. British Med J Open 2012, 2:e000601. doi:10.1136/bmjopen-2011-000601
• [25]Panamonta N, Prathipanawatr T, Panamonta O: Factors influencing chronic diabetic complications in type 1 diabetes. Southeast Asian J Trop Med 2012, 43:1245-1251.