Presented at the Neonatal Society 2007 Autumn Meeting.
Weindling AM1, Rackham O2, Paize F1, Golightly S3
1 School of Reproductive and Developmental Medicine, University of Liverpool, Liverpool Women’s Hospital, Crown Street, Liverpool L8 7SS, UK
2 Arrowe Park Hospital, Wirral, UK
3 Confidential Enquiry for Maternal and Child Health, UK
Aims: 1. To define the causes of stillbirths (SBs) and neonatal deaths (NNDs) in babies of women with type 1 (insulin-dependent) and type 2 (non-insulin dependent) diabetes mellitus (DM). 2. To examine the hypothesis that the causes of perinatal mortality are the same for women with type 1 and type 2 diabetes.
Methods: A study of all 3808 pregnant women with pre-existing type 1 and type 2 diabetes was undertaken by the Confidential Enquiry for Maternal and Child Health (CEMACH) in England, Wales and Northern Ireland between 1/3/02 and 28/2/03 with follow up to 28 days after delivery. The case notes of 93 mothers and babies where there was a SB or NND were examined: 85 deaths of babies born during the 12-month period and a further 8 deaths to mothers who booked before 28/2/03 but whose pregnancy resulted in a death afterwards. CEMACH has section 60 ethical approval.
Results: There was no difference in crude pregnancy outcome rates for women with type 1 and type 2 DM. The median (range) maternal age was 28 y (19 – 41) for 59 mothers with type 1 DM and 34 y (22 – 42) for 34 mothers with type 2 DM. The median (range) gestation for SB or NND was 35 w (24 – 39) for mothers with type 1 DM and 34 w (26 – 40) for those with type 2 DM.
The age-adjusted stillbirth rate for women with DM was 26.8 (95% CI 19.8-33.8, national rate 5.7) and the NND rate was 9.3 (95% CI 5.2-13.3, national rate 3.6). For women with DM, the increased risk (rate ratio) for SB was 4.7 (95% CI 3.7-6.0) and for NND 2.6 (95% CI 1.7-3.9). The causes of death were as follows:
Conclusion: Mothers with Type 1 DM were younger than those with Type 2 DM. Perinatal deaths in mothers with DM occurred late (at about 34 w). There was no difference in outcome for type 1 DM compared with type 2 DM: poor blood glucose control is probably the most important factor. We speculate that the probable mechanism for these deaths is placental insufficiency due to an angiopathy caused by hyperglycaemia.