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Type 1 Diabetes Mellitus and adverse pregnancy outcomes: experience from Victoria’s largest healthcare service (#260)

Sally Abell 1 2 , Jacqueline Boyle 1 3 , Christine East 3 , Michelle Knight 3 , Sanjeeva Ranasinha 1 , Georgia Soldatos 1 2 , Euan Wallace 3 4 , John Regan 3 , Helena Teede 1 2
  1. Monash Centre for Health Research and Implementation, Monash University, Melbourne
  2. Diabetes and Vascular Medicine Unit, Monash Health, Victoria
  3. Monash Women's Services, Monash Health, Clayton, Victoria
  4. The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria

Aim
To compare pregnancy outcomes in women with and without T1DM attending a quaternary (Level 6) maternity service. 

Methods
Large-scale retrospective observational study of singleton births >20 weeks gestation at Monash Health 2010-2013. Data (pregnancy details, maternal and neonatal outcomes) were extracted from the Birthing Outcomes System database. Descriptive statistics are presented and multivariable regression analysis was used to examine associations between T1DM and pregnancy outcome, adjusting for potential confounders including age, ethnicity, BMI, parity and smoking.

Results
Outcomes for 109 women with T1DM and 27,570 women with normal glucose tolerance were analysed. Women with T1DM had higher BMI than women without diabetes (median+IQR: 26.7+6.1 vs 24.4+6.6 kg/m2,p<0.001), but there was no difference in age, parity or smoking status.

Reflecting hospital protocols, compared to those without diabetes, women with T1DM were more likely to give birth earlier (mean gestation 39.0±3.0 vs 36.0±3.0 weeks, p<0.001), undergo induction of labour (21.4% vs 46.8%, p<0.001) or caesarean section (26.8% vs 61.5%, p<0.001) and the baby was more likely to be admitted to the special care nursery (18.7% vs 95.4%, p<0.001). Compared to women without diabetes, women with T1DM were more likely to have pre-eclampsia (2.4% vs 5.5%, p=0.035), but not gestational hypertension. Compared to babies of women without diabetes, babies of women with T1DM were more likely to have had hypoglycaemia (4.2% vs 39.5%, p<0.001), jaundice (6.9% vs 38.5% p<0.001), respiratory distress (4.1% vs 16.5%, p<0.001) and macrosomia (8.2% vs 27.5%, p<0.001). Babies born vaginally to women with T1DM were more likely to have had shoulder dystocia (2.5% vs 16.7%, p<0.001) or low Apgar score (<7) at 5 minutes (3.0% vs 14.6%, p<0.001). Despite earlier birth, stillbirth was higher to women with than without T1DM (3.7% vs 1.1%, p=0.012).

Conclusion

T1DM remains associated with significantly increased rates of several adverse obstetric and perinatal outcomes, reinforcing the importance of vigilant screening and active management.