Mothers entering pregnancy with diabetes face higher risks of stillbirth and infant death

Fri, 29 Nov 2013
Women that have diabetes going into pregnancy have increased rates of stillbirth (4.6 times higher) and infant death (1.9 times higher) than mothers without diabetes.

Stillbirth is when the developing foetus dies after 20 weeks of the pregnancy and infant death is death of a baby before its first birthday.

The figures come from analysis of pregnancies by Newcastle University, the South Tees NHS Trust and Public Health England. Women who were assessed were those that were part of the Northern Diabetes in Pregnancy survey which included 1,206 women with type 1 diabetes and 342 women with type 2 diabetes. These figures were compared to data from the Northern Perinatal Morbidity and Mortality Survey.

Researchers found that women with an HbA1c value over 48 mmol/mol (6.6% or above) had higher risks of stillbirth and infant death. Higher risks were also observed in women who had developed retinopathy before their pregnancy and also those with low folic acid supplementation.

In women without diabetes, the rate of stillbirth is 0.7% and infant death 0.4%. In women with diabetes the rates of stillbirth was measured at 3% and infant death at 0.7%. The risks were similar whether mothers had type 1 or type 2 diabetes.

The researchers note that the significantly increased rates for mothers with diabetes as a whole is somewhat to be expected as average HbA1c amongst the women with diabetes was 62 mmol/mol (7.8%), which is significantly higher than the NICE target for blood glucose control in pregnancy which is 43 mmol/mol (6.1%).

The news can therefore be interpreted as highlighting the importance of adequately planning for pregnancy, including getting blood glucose levels under good control and taking folic acid 3 months before becoming pregnant.

Going into pregnancy with a high HbA1c can make it a struggle to suddenly improve blood glucose control and so it is highly recommended that women aim to bring their HbA1c within, or at least closer to, the target level of 43 mmol/mol before becoming pregnant.
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