Suboptimal
Glycemic Control Increases Risk of Stillbirth
Women with pregestational type 1 diabetes who
experience stillbirths are more likely to have
suboptimal glycemic control during pregnancy.
They
are also more likely to have diabetic nephropathy,
to smoke and to have low educational and social
attainment. That's according to an audit of 25
stillbirths experienced by 22 type 1 diabetic
women, the results of which appear in the May
issue of Diabetes Care. Three of the women had
a history of two stillbirths.
Dr. Jeannet Lauenborg from National University
Hospital Rigshospitalet in Copenhagen and a Danish
team found a cause for seven stillbirths, namely
chorioamnionitis, ketoacidosis, placental abruption,
and severe intrauterine growth retardation.
They found a "likely" cause for stillbirth
in six cases, namely severe malformations, multiple
placental infarctions, and thrombosis in the umbilical
cord.
There was no obvious explanation for the remaining
12 cases of stillbirth. However, in 9 of these
12 (67%) cases, glycemic control was suboptimal
(HbA1c > 7.5%). Glycemic control in both early
and late pregnancy was poorer in the stillbirth
group when compared with a reference group consisting
of 236 type 1 diabetic women without stillbirth.
Suboptimal glycemic control, the authors note,
may "predispose to fetal distress, due to
fetal hyperinsulinemia, acidosis, and hyperlacticemia,
as maternal hyperglycemia and elevated HbA1c are
risk factors for fetal asphyxia, possibly leading
to intrauterine death."
The team also found that the incidence of diabetic
nephropathy was six times higher in the stillbirth
group than the reference group. Low educational
level, high unemployment, and smoking also characterized
the stillbirth group.
These findings, Dr. Lauenborg and colleagues conclude,
highlight a group of diabetic women deserving
"more attention" during pregnancy, especially
with regards to optimizing their glycemic control.
Diabetes Care 2003;26:1385-1389.
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Having
the results of your patients A1c while you
are with them can motivate them to better self-control.
www.a1cnow.net
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