Presented at the Neonatal Society 2005 Autumn Meeting.
Acolet D, Fleming K, Bailey J, Weindling AM, Hawdon J, Macintosh M
Confidential Enquiry into Maternal and Child Health (CEMACH) Central Office, 188 Baker Street, London NW1 5SD, UK
Background/Aim: In 1989 the St Vincent declaration set a 5 year aim to achieve outcomes in diabetic pregnancies that were similar to those in non-diabetic pregnancies (1). In the mid 1990s, poor outcomes were reported in a number of regional UK studies. This prompted CEMACH to start a national enquiry programme to: a) provide information on perinatal mortality, congenital anomalies and other adverse neonatal outcomes for diabetic pregnancies in England, Wales and Northern Ireland; and b) assess clinical standards of care in women and babies from preconception to the postnatal period. We report on main outcomes.
Methods: Design: Descriptive population based study. Population: Pregnancies in women with pregestational diabetes (type 1 and 2) delivering or booking from 1st March 2002 to 28th February 2003. Data collection: By health professionals in 231 maternity units using a structured questionnaire. CEMACH attained Section 60 approval for its programme of work in December 2003.
Results: There were 3808 pregnancies to women with diabetes reported to CEMACH (1 in 260 births in E, W and NI): 2767 (73%) type 1 diabetes and 1041 (27%) type 2 diabetes. Maternal-age adjusted mortality rates showed a significant increase in stillbirth, perinatal and neonatal mortality rates compared to the general population (see table). There was no apparent difference in mortality between type 1 and 2 diabetes.
The prevalence of major congenital anomalies was 41.8 per 1000 births compared to 21 per 1000 (prevalence ratio = 1.9 [1.6-2.3] p<0.001), using maternal age-specific data for 2002-03 from the European surveillance of congenital anomalies registry (EUROCAT). The difference between observed and expected prevalence of anomalies related to a particular increase seen in: a) neural tube defects, n=12, (prevalence ratio = 3.4 [1.5-7.4] p<0.001); and b) congenital heart disease, n=60, (prevalence ratio = 3.3 [2.3-4.6] p<0.001).
A total of 1296/3536 babies (36.7%) delivered prematurely (compared to 7.3% (p<0.001) in the general population: Office for National Statistics, 2002). Birth weight distribution of singleton babies showed a 2 fold increase in macrosomic babies (21% ≥ 4000g versus 11% (p<0.001) in rhe general population: NHS maternity statistics England 2002). There was no significant difference in birth weight distribution between type 1 and 2 diabetes (p=0.3). Shoulder dystocia incidence in singleton vaginal births of these diabetic pregnancies was 7.9% and Erb’s palsy incidence was 4.5/1000 (compared with 0.42/1000 in UK: British Paediatric Surveillance Unit 1999). Overall admission to a neonatal unit was 56% including 32.6% of term babies admitted to a neonatal unit for special care. These findings were found in association with a poor preparation for pregnancy: 35% of mothers received preconception counselling, 37% had a preconception glycaemic control measurement and 39% took folic acid supplements before conception.
Conclusion: In the UK in 2002, babies of mothers with diabetes were at increased risk of poor outcome both in term of mortality and morbidity compared to those from normal pregnancies. Babies of women with type 1 and 2 diabetes had similar apparent risks of a poor outcome.
References
1. Diabetes Care and Research in Europe: The Saint Vincent Declaration. Diabetic Medicine 1990: 7; 360