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      Pregnancy outcomes in women with onset of type 1 diabetes mellitus less than 18 years of age

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          Abstract

          Background

          Pregnancy in women with type 1 diabetes mellitus (T1DM) is associated with an increased risk of congenital malformations, obstetric complications and neonatal morbidity. This study aims to investigate maternal, perinatal and neonatal outcomes of pregnancies in women with onset of T1DM less than 18 years of age.

          Methods

          This retrospective cohort study extracted data regarding prenatal, intrapartum and postnatal outcomes of pregnancies in women with onset of T1DM<18 years identified from the diabetes in pregnancy register at University Maternity Hospital Limerick, treated from July 1, 2007 to July 1, 2017.

          Results

          Seventeen women with onset of T1DM <18 years gave birth to 23 live infants during the period studied. 73.9% of pregnancies were unplanned. Only 21.7% of pregnancies took preconceptual folic acid. 60.9% of infants required treatment for hypoglycemia.

          Conclusion

          The high prevalence of unplanned pregnancy and poor uptake of prepregnancy care must be improved on in order to improve outcomes for this high-risk group.

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          A proposal for a new method of evaluation of the newborn infant.

          V APGAR (2015)
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            Obstetric and Perinatal Outcomes in Type 1 Diabetic Pregnancies

            Martina Persson, Mikael Norman, Ulf Hanson (2009)
            OBJECTIVE To perform comparative analyses of obstetric and perinatal outcomes between type 1 diabetic pregnancies and the general obstetric population in Sweden between 1991 and 2003. RESEARCH DESIGN AND METHODS This was a population-based study. Data were obtained from the Medical Birth Registry, covering >98% of all pregnancies in Sweden. A total of 5,089 type 1 diabetic pregnancies and 1,260,207 control pregnancies were included. Odds ratios (ORs) were adjusted for group differences in maternal age, parity, BMI, chronic hypertensive disease, smoking habits, and ethnicity. RESULTS In type 1 diabetes, preeclampsia was significantly more frequent (OR 4.47 [3.77–5.31]) as was delivery by cesarean section (5.31 [4.97–5.69]) compared with results for the general population. Stillbirth (3.34 [2.46–4.55]), perinatal mortality (3.29 [2.50–4.33]), and major malformations (2.50 [2.13–2.94]) were more common in type 1 diabetic than in control pregnancies. The risk of very preterm birth (<32 gestational weeks) was also higher among type 1 diabetic women (3.08 [2.45–3.87]). The incidence of fetal macrosomia (birth weight ≥2 SD above the mean) was increased in the diabetic group (11.45 [10.61–12.36]). CONCLUSIONS Type 1 diabetes in pregnancy is still associated with considerably increased rates of adverse obstetric and perinatal outcomes. The eightfold increased risk for fetal macrosomia in type 1 diabetic pregnancies is unexpected and warrants further investigation.
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              Glycemic targets in the second and third trimester of pregnancy for women with type 1 diabetes.

              Michael Maresh, Valerie A Holmes, Christopher C. Patterson … (2015)
              To assess the relationship between second and third trimester glycemic control and adverse outcomes in pregnant women with type 1 diabetes, as uncertainty exists about optimum glycemic targets.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Open Diabetes Res Care
                Journal ID (iso-abbrev): BMJ Open Diabetes Res Care
                Journal ID (hwp): bmjdrc
                Journal ID (publisher-id): bmjdrc
                Title: BMJ Open Diabetes Research & Care
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2052-4897
                Publication date Collection: 2020
                Publication date (Electronic): 28 April 2020
                Volume: 8
                Issue: 1
                Electronic Location Identifier: e001080
                Affiliations
                [1 ]departmentDepartment of Paediatrics , University Hospital Limerick , Dooradoyle, Limerick, Ireland
                [2 ]departmentGraduate Entry Medical School , University of Limerick , Limerick, Ireland
                [3 ]departmentDepartment of General Medicine , University Hospital Limerick , Dooradoyle, Limerick, Ireland
                [4 ]departmentDepartment of Obstetrics , University Maternity Hospital Limerick , Limerick, Ireland
                Author notes
                [Correspondence to ] Dr Roy Gavin Stone; roygavinstone@ 123456gmail.com
                Author information
                http://orcid.org/0000-0003-1731-384X
                Article
                Publisher ID: bmjdrc-2019-001080
                DOI: 10.1136/bmjdrc-2019-001080
                PMC ID: 7213751
                PubMed ID: 32349996
                SO-VID: dd99d03e-dae8-49b2-a4ce-3935e3973fd9
                Copyright © © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
                License:

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                Date received : 18 December 2019
                Date revision received : 13 February 2020
                Date accepted : 09 March 2020
                Categories
                Subject: Clinical Care/Education/Nutrition
                Subject: 1506
                Subject: 1866
                Custom metadata
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                Keywords: pregnancy preparedness,neonatal,type 1
                Data availability:
                Keywords: pregnancy preparedness, neonatal, type 1

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