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Pregestational Diabetes Linked to Higher Rates of Perinatal Death and Anomalies

The offspring of women with pregestational diabetes, either type 1 or type 2, are at a three-fold increased risk for perinatal mortality, and a two-fold increased risk for congenital anomalies, compared with the general population. This is particularly disturbing, lead researcher Dr. Mary C. M. Macintosh and her associates maintain, because of the increasing incidence of type 2 diabetes in young adults, and the evidence that women in this study were receiving suboptimal periconceptional care, with few achieving normoglycemia during the first trimester.

Dr. Macintosh and other members of the Confidential Enquiry into Maternal and Child Health in London obtained data regarding pregnancy outcomes among 2359 women with diabetes that was diagnosed at least one year prior to their becoming pregnant. Diabetes was type 1 in 1707 women, type 2 in 652.

As reported in BMJ, good glycemic control, indicated by a glycated hemoglobin (HbA1c) level < 7%, was achieved by 596 of the women (37%).

The median HbA1c was 7.9% for women whose babies had a congenital abnormality, 8.0% for those with a normally formed stillbirth or neonatal death, and 7.4% for women who had a normally formed baby still alive on day 28.

Perinatal mortality was similar for type 1 and type 2 diabetics: 31.7 and 32.2 per 1000 births, respectively, which was nearly four-fold higher than the rate of 8.5 per 1000 in the general maternity population in 2002.

The authors identified 141 major congenital anomalies among the offspring among the pregnant women (46 per 1000 births), which compares with 21 per 1000 births in the general population, for a prevalence ratio (PR) of 2.2.

Statistically significant increases in anomalies among offspring of diabetics compared with the general population were observed in the nervous system (PR 2.7) and the heart (PR = 3.4). Most CNS anomalies were related to neural tube defects, which leads Dr. Macintosh and her team to advise that "women with diabetes should take a higher than usual dose (5 mg) of folic acid from before conception up to week 12."

They add: "More work is needed to elucidate how women with either type of diabetes can best be enabled to improve the outcomes of their pregnancy."

BMJ Online First, 2006 Online First, published on June 16

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