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Type 2 Diabetes Mellitus and adverse pregnancy outcomes: experience from Victoria’s largest healthcare service (#261)

Sally Abell 1 2 , Jacqueline Boyle 1 3 , Christine East 3 , Amanda Kendall 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 T2DM attending a quaternary (Level 6) maternity service.

Methods
Large-scale retrospective observational study of all 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 T2DM and pregnancy outcome, adjusting for potential confounders including age, ethnicity, BMI, parity and smoking.

Results
Outcomes for 142 women with T2DM and 27,570 women with normal glucose tolerance were analysed. Women with T2DM were older (mean±SD: 33.7±5.3 vs 29.5±5.4 years) and had higher BMI (median+IQR: 32.9+10.8 vs 24.4+6.7 kg/m2), but were less likely to be parous than women without diabetes (all p<0.001).

Reflecting hospital protocols, compared to those without diabetes, women with T2DM were more likely to give birth earlier (mean gestation 39.0±3.0 vs 37.0±3.0 weeks, p<0.001), undergo induction of labour (21.4% vs 53.5%, p<0.001) or caesarean section (26.8% vs 52.8%, p<0.001) and the baby was more likely to be admitted to the special care nursery (18.7% vs 77.5%, p<0.001). Compared to those without diabetes, women with T2DM were more likely to have pre-eclampsia (2.4% vs 9.2%, p<0.001) and gestational hypertension (1.9% vs 4.9%, p=0.010). Compared to babies of women without diabetes, babies of women with T2DM were more likely to have had hypoglycaemia (4.2% vs 21.8%, p<0.001), jaundice (6.9% vs 20.4% p<0.001), and macrosomia (8.2% vs 17.6%, p<0.001). Babies born vaginally to women with T2DM were more likely to have had shoulder dystocia (2.5% vs 7.5%, p=0.009), or low Apgar score (<7) at 5 minutes (3.0% vs 9.0%, p<0.005). There were no differences in rates of respiratory distress or stillbirth.

Conclusions
T2DM remains associated with significantly increased rates of several adverse obstetric and perinatal outcomes, reinforcing the importance of vigilant screening and active management.