Diabetes and pregnancy

national trends over a 15 year period

Sharon T. Mackin, Scott M. Nelson, Joannes J. Kerssens, Rachael Wood, Sarah Wild, Helen M. Colhoun, Graham P. Leese, Sam Philip, Robert S. Lindsay*, SDRN Epidemiology Grp

*Corresponding author for this work

Research output: Contribution to journalArticle

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Abstract

Aims/hypothesis We aimed to examine time trends in national perinatal outcomes in pregnancies complicated by pre-existing type 1 or type 2 diabetes.

Methods We analysed episode-level data on all obstetric inpatient delivery events (live or stillbirth) between 1 April 1998 and 31 March 2013 (n = 813,921) using the Scottish Morbidity Record (SMR02). Pregnancies to mothers with type 1 (n = 3229) and type 2 (n = 1452) diabetes were identified from the national diabetes database (Scottish Care Information-Diabetes), and perinatal outcomes were compared among women with type 1 diabetes, type 2 diabetes and those without diabetes.

Results The number of pregnancies complicated by diabetes increased significantly, by 44% in type 1 diabetes and 90% in type 2 diabetes, across the 15 years examined, to rates of 1 in 210 and 1 in 504 deliveries, respectively. Compared with women without diabetes, delivery occurred 2.6 weeks earlier (type 1 diabetes 36.7 +/- 2.3 weeks) and 2 weeks earlier (type 2 diabetes 37.3 +/- 2.4 weeks), respectively, showing significant reductions for both type 1 (from 36.7 weeks to 36.4 weeks, p = 0.03) and type 2 (from 38.0 weeks to 37.2 weeks, p <0.001) diabetes across the time period. The proportions of preterm delivery were markedly increased in women with diabetes (35.3% type 1 diabetes, 21.8% type 2 diabetes, 6.1% without diabetes; p <0.0001), and these proportions increased with time for both groups (p <0.005). Proportions of elective Caesarean sections (29.4% type 1 diabetes, 30.5% type 2 diabetes, 9.6% without diabetes) and emergency Caesarean sections (38.3% type 1 diabetes, 29.1% type 2 diabetes, 14.6% without diabetes) were greatly increased in women with diabetes and increased over time except for stable rates of emergency Caesarean section in type 1 diabetes. Gestational age-, sex- and parity-adjusted z score for birthweight (1.33 +/- 1.34; p <0.001) were higher in type 1 diabetes and increased over time from 1.22 to 1.47 (p <0.001). Birthweight was also increased in type 2 diabetes (0.94 +/- 1.34; p <0.001) but did not alter with time. There were 65 perinatal deaths in offspring of mothers with type 1 diabetes and 39 to mothers with type 2 diabetes, representing perinatal mortality rates of 20.1 (95% CI 14.7, 24.3) and 26.9 (16.7, 32.9) per 1000 births, respectively, and rates 3.1 and 4.2 times, respectively, those observed in the non-diabetic population (p <0.001). Stillbirth rates in type 1 and type 2 diabetes were 4.0-fold and 5.1-fold that in the non-diabetic population (p <0.001). Perinatal mortality and stillbirth rates showed no significant fall over time despite small falls in the rates for the non-diabetic population.

Conclusions/interpretation Women with diabetes are receiving increased intervention in pregnancy (earlier delivery, increased Caesarean section rates), but despite this, higher birthweights are being recorded. Improvements in rates of stillbirth seen in the general population are not being reflected in changes in stillbirth or perinatal mortality in our population with diabetes.

Original languageEnglish
Pages (from-to)1081-1088
Number of pages8
JournalDiabetologia
Volume61
Issue number5
Early online date11 Jan 2018
DOIs
Publication statusPublished - May 2018

Keywords

  • Diabetes
  • Epidemiology
  • Perinatal
  • Pregnancy
  • Trends
  • Type 1 diabetes
  • Type 2 diabetes
  • Type-1
  • Women
  • Outcomes
  • Netherlands
  • Mortality
  • Scotland

Cite this

Mackin, S. T., Nelson, S. M., Kerssens, J. J., Wood, R., Wild, S., Colhoun, H. M., ... SDRN Epidemiology Grp (2018). Diabetes and pregnancy: national trends over a 15 year period. Diabetologia, 61(5), 1081-1088. https://doi.org/10.1007/s00125-017-4529-3

Diabetes and pregnancy : national trends over a 15 year period. / Mackin, Sharon T.; Nelson, Scott M.; Kerssens, Joannes J.; Wood, Rachael; Wild, Sarah; Colhoun, Helen M.; Leese, Graham P.; Philip, Sam; Lindsay, Robert S.; SDRN Epidemiology Grp.

In: Diabetologia, Vol. 61, No. 5, 05.2018, p. 1081-1088.

Research output: Contribution to journalArticle

Mackin, ST, Nelson, SM, Kerssens, JJ, Wood, R, Wild, S, Colhoun, HM, Leese, GP, Philip, S, Lindsay, RS & SDRN Epidemiology Grp 2018, 'Diabetes and pregnancy: national trends over a 15 year period', Diabetologia, vol. 61, no. 5, pp. 1081-1088. https://doi.org/10.1007/s00125-017-4529-3
Mackin ST, Nelson SM, Kerssens JJ, Wood R, Wild S, Colhoun HM et al. Diabetes and pregnancy: national trends over a 15 year period. Diabetologia. 2018 May;61(5):1081-1088. https://doi.org/10.1007/s00125-017-4529-3
Mackin, Sharon T. ; Nelson, Scott M. ; Kerssens, Joannes J. ; Wood, Rachael ; Wild, Sarah ; Colhoun, Helen M. ; Leese, Graham P. ; Philip, Sam ; Lindsay, Robert S. ; SDRN Epidemiology Grp. / Diabetes and pregnancy : national trends over a 15 year period. In: Diabetologia. 2018 ; Vol. 61, No. 5. pp. 1081-1088.
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abstract = "Aims/hypothesis We aimed to examine time trends in national perinatal outcomes in pregnancies complicated by pre-existing type 1 or type 2 diabetes.Methods We analysed episode-level data on all obstetric inpatient delivery events (live or stillbirth) between 1 April 1998 and 31 March 2013 (n = 813,921) using the Scottish Morbidity Record (SMR02). Pregnancies to mothers with type 1 (n = 3229) and type 2 (n = 1452) diabetes were identified from the national diabetes database (Scottish Care Information-Diabetes), and perinatal outcomes were compared among women with type 1 diabetes, type 2 diabetes and those without diabetes.Results The number of pregnancies complicated by diabetes increased significantly, by 44{\%} in type 1 diabetes and 90{\%} in type 2 diabetes, across the 15 years examined, to rates of 1 in 210 and 1 in 504 deliveries, respectively. Compared with women without diabetes, delivery occurred 2.6 weeks earlier (type 1 diabetes 36.7 +/- 2.3 weeks) and 2 weeks earlier (type 2 diabetes 37.3 +/- 2.4 weeks), respectively, showing significant reductions for both type 1 (from 36.7 weeks to 36.4 weeks, p = 0.03) and type 2 (from 38.0 weeks to 37.2 weeks, p <0.001) diabetes across the time period. The proportions of preterm delivery were markedly increased in women with diabetes (35.3{\%} type 1 diabetes, 21.8{\%} type 2 diabetes, 6.1{\%} without diabetes; p <0.0001), and these proportions increased with time for both groups (p <0.005). Proportions of elective Caesarean sections (29.4{\%} type 1 diabetes, 30.5{\%} type 2 diabetes, 9.6{\%} without diabetes) and emergency Caesarean sections (38.3{\%} type 1 diabetes, 29.1{\%} type 2 diabetes, 14.6{\%} without diabetes) were greatly increased in women with diabetes and increased over time except for stable rates of emergency Caesarean section in type 1 diabetes. Gestational age-, sex- and parity-adjusted z score for birthweight (1.33 +/- 1.34; p <0.001) were higher in type 1 diabetes and increased over time from 1.22 to 1.47 (p <0.001). Birthweight was also increased in type 2 diabetes (0.94 +/- 1.34; p <0.001) but did not alter with time. There were 65 perinatal deaths in offspring of mothers with type 1 diabetes and 39 to mothers with type 2 diabetes, representing perinatal mortality rates of 20.1 (95{\%} CI 14.7, 24.3) and 26.9 (16.7, 32.9) per 1000 births, respectively, and rates 3.1 and 4.2 times, respectively, those observed in the non-diabetic population (p <0.001). Stillbirth rates in type 1 and type 2 diabetes were 4.0-fold and 5.1-fold that in the non-diabetic population (p <0.001). Perinatal mortality and stillbirth rates showed no significant fall over time despite small falls in the rates for the non-diabetic population.Conclusions/interpretation Women with diabetes are receiving increased intervention in pregnancy (earlier delivery, increased Caesarean section rates), but despite this, higher birthweights are being recorded. Improvements in rates of stillbirth seen in the general population are not being reflected in changes in stillbirth or perinatal mortality in our population with diabetes.",
keywords = "Diabetes, Epidemiology, Perinatal, Pregnancy, Trends, Type 1 diabetes, Type 2 diabetes, Type-1, Women, Outcomes, Netherlands, Mortality, Scotland",
author = "Mackin, {Sharon T.} and Nelson, {Scott M.} and Kerssens, {Joannes J.} and Rachael Wood and Sarah Wild and Colhoun, {Helen M.} and Leese, {Graham P.} and Sam Philip and Lindsay, {Robert S.} and {SDRN Epidemiology Grp}",
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year = "2018",
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TY - JOUR

T1 - Diabetes and pregnancy

T2 - national trends over a 15 year period

AU - Mackin, Sharon T.

AU - Nelson, Scott M.

AU - Kerssens, Joannes J.

AU - Wood, Rachael

AU - Wild, Sarah

AU - Colhoun, Helen M.

AU - Leese, Graham P.

AU - Philip, Sam

AU - Lindsay, Robert S.

AU - SDRN Epidemiology Grp

N1 - The SDRN Epidemiology Group receives financial support from the Chief Scientists Office of the Scottish Government.

PY - 2018/5

Y1 - 2018/5

N2 - Aims/hypothesis We aimed to examine time trends in national perinatal outcomes in pregnancies complicated by pre-existing type 1 or type 2 diabetes.Methods We analysed episode-level data on all obstetric inpatient delivery events (live or stillbirth) between 1 April 1998 and 31 March 2013 (n = 813,921) using the Scottish Morbidity Record (SMR02). Pregnancies to mothers with type 1 (n = 3229) and type 2 (n = 1452) diabetes were identified from the national diabetes database (Scottish Care Information-Diabetes), and perinatal outcomes were compared among women with type 1 diabetes, type 2 diabetes and those without diabetes.Results The number of pregnancies complicated by diabetes increased significantly, by 44% in type 1 diabetes and 90% in type 2 diabetes, across the 15 years examined, to rates of 1 in 210 and 1 in 504 deliveries, respectively. Compared with women without diabetes, delivery occurred 2.6 weeks earlier (type 1 diabetes 36.7 +/- 2.3 weeks) and 2 weeks earlier (type 2 diabetes 37.3 +/- 2.4 weeks), respectively, showing significant reductions for both type 1 (from 36.7 weeks to 36.4 weeks, p = 0.03) and type 2 (from 38.0 weeks to 37.2 weeks, p <0.001) diabetes across the time period. The proportions of preterm delivery were markedly increased in women with diabetes (35.3% type 1 diabetes, 21.8% type 2 diabetes, 6.1% without diabetes; p <0.0001), and these proportions increased with time for both groups (p <0.005). Proportions of elective Caesarean sections (29.4% type 1 diabetes, 30.5% type 2 diabetes, 9.6% without diabetes) and emergency Caesarean sections (38.3% type 1 diabetes, 29.1% type 2 diabetes, 14.6% without diabetes) were greatly increased in women with diabetes and increased over time except for stable rates of emergency Caesarean section in type 1 diabetes. Gestational age-, sex- and parity-adjusted z score for birthweight (1.33 +/- 1.34; p <0.001) were higher in type 1 diabetes and increased over time from 1.22 to 1.47 (p <0.001). Birthweight was also increased in type 2 diabetes (0.94 +/- 1.34; p <0.001) but did not alter with time. There were 65 perinatal deaths in offspring of mothers with type 1 diabetes and 39 to mothers with type 2 diabetes, representing perinatal mortality rates of 20.1 (95% CI 14.7, 24.3) and 26.9 (16.7, 32.9) per 1000 births, respectively, and rates 3.1 and 4.2 times, respectively, those observed in the non-diabetic population (p <0.001). Stillbirth rates in type 1 and type 2 diabetes were 4.0-fold and 5.1-fold that in the non-diabetic population (p <0.001). Perinatal mortality and stillbirth rates showed no significant fall over time despite small falls in the rates for the non-diabetic population.Conclusions/interpretation Women with diabetes are receiving increased intervention in pregnancy (earlier delivery, increased Caesarean section rates), but despite this, higher birthweights are being recorded. Improvements in rates of stillbirth seen in the general population are not being reflected in changes in stillbirth or perinatal mortality in our population with diabetes.

AB - Aims/hypothesis We aimed to examine time trends in national perinatal outcomes in pregnancies complicated by pre-existing type 1 or type 2 diabetes.Methods We analysed episode-level data on all obstetric inpatient delivery events (live or stillbirth) between 1 April 1998 and 31 March 2013 (n = 813,921) using the Scottish Morbidity Record (SMR02). Pregnancies to mothers with type 1 (n = 3229) and type 2 (n = 1452) diabetes were identified from the national diabetes database (Scottish Care Information-Diabetes), and perinatal outcomes were compared among women with type 1 diabetes, type 2 diabetes and those without diabetes.Results The number of pregnancies complicated by diabetes increased significantly, by 44% in type 1 diabetes and 90% in type 2 diabetes, across the 15 years examined, to rates of 1 in 210 and 1 in 504 deliveries, respectively. Compared with women without diabetes, delivery occurred 2.6 weeks earlier (type 1 diabetes 36.7 +/- 2.3 weeks) and 2 weeks earlier (type 2 diabetes 37.3 +/- 2.4 weeks), respectively, showing significant reductions for both type 1 (from 36.7 weeks to 36.4 weeks, p = 0.03) and type 2 (from 38.0 weeks to 37.2 weeks, p <0.001) diabetes across the time period. The proportions of preterm delivery were markedly increased in women with diabetes (35.3% type 1 diabetes, 21.8% type 2 diabetes, 6.1% without diabetes; p <0.0001), and these proportions increased with time for both groups (p <0.005). Proportions of elective Caesarean sections (29.4% type 1 diabetes, 30.5% type 2 diabetes, 9.6% without diabetes) and emergency Caesarean sections (38.3% type 1 diabetes, 29.1% type 2 diabetes, 14.6% without diabetes) were greatly increased in women with diabetes and increased over time except for stable rates of emergency Caesarean section in type 1 diabetes. Gestational age-, sex- and parity-adjusted z score for birthweight (1.33 +/- 1.34; p <0.001) were higher in type 1 diabetes and increased over time from 1.22 to 1.47 (p <0.001). Birthweight was also increased in type 2 diabetes (0.94 +/- 1.34; p <0.001) but did not alter with time. There were 65 perinatal deaths in offspring of mothers with type 1 diabetes and 39 to mothers with type 2 diabetes, representing perinatal mortality rates of 20.1 (95% CI 14.7, 24.3) and 26.9 (16.7, 32.9) per 1000 births, respectively, and rates 3.1 and 4.2 times, respectively, those observed in the non-diabetic population (p <0.001). Stillbirth rates in type 1 and type 2 diabetes were 4.0-fold and 5.1-fold that in the non-diabetic population (p <0.001). Perinatal mortality and stillbirth rates showed no significant fall over time despite small falls in the rates for the non-diabetic population.Conclusions/interpretation Women with diabetes are receiving increased intervention in pregnancy (earlier delivery, increased Caesarean section rates), but despite this, higher birthweights are being recorded. Improvements in rates of stillbirth seen in the general population are not being reflected in changes in stillbirth or perinatal mortality in our population with diabetes.

KW - Diabetes

KW - Epidemiology

KW - Perinatal

KW - Pregnancy

KW - Trends

KW - Type 1 diabetes

KW - Type 2 diabetes

KW - Type-1

KW - Women

KW - Outcomes

KW - Netherlands

KW - Mortality

KW - Scotland

U2 - 10.1007/s00125-017-4529-3

DO - 10.1007/s00125-017-4529-3

M3 - Article

VL - 61

SP - 1081

EP - 1088

JO - Diabetologia

JF - Diabetologia

SN - 0012-186X

IS - 5

ER -