The impact of diabetes mellitus on the course and outcome of pregnancy during a 5-year follow-up
Authors: Mitrovic Milena , Stojic Sinisa , Tesic Dragan , Popovic Djordje , Rankov Olivera , Tomic-Naglic Dragana , Novakovic-Paro Jovanka , Pejin Radoslav , Bulatovic Sanja , Todorovic-Veljic Masa , Kovacev-Zavisic Branka 
Published: October 2014

Background/Aim. Women with diabetes, especially diabetes type 1, have worse
pregnancy outcomes, as well as increased incidence of spontaneous abortions,
pre-eclampsia, fetal macrosomia, preterm delivery, congenital anomalies and
perinatal mortality. The aim of this study was to analyze the course and
outcome of pregnancy in the patients with diabetes in relation to the group
of healthy women regarding preterm delivery, perinatal morbidity and
mortality. Also, the aim was to compare pregnancy outcomes in the patients
with pre-existing diabetes type 1 and the patients with gestational and
diabetes type 2. Methods. This retrospective study included 156 diabetic
women treated at the Clinic of Endocrinology, Diabetes and Metabolic Diseases
and Gynecology and Obstetrics Clinic of the Clinical Center of Vojvodina from
2006 to 2010. There were 94 patients with gestational diabetes, 48 with type
1 diabetes, and 14 patients with type 2 diabetes. The control group included
106 healthy women hospitalized at the Gynecology and Obstetrics Clinic.
Results. The women with type 1 diabetes presented with a statistically
significantly higher incidence of cesarean section than those without
diabetes, or with type 2 or gestational diabetes (p < 0.0001); the women with
type 1 diabetes delivered at an earlier week of gestation (WG) in regard to
women without diabetes, or with type 2 or gestational diabetes (p = 0.0017
and p = 0.02, respectively). The incidence of perinatal morbidity:
hypoglycemia (p < 0.001), pathological jaundice (p = 0.0021), and other
neonatal pathologies at birth (p = 0.0031), was statistically significantly
higher and Apgar scores after 1 minute (p = 0.0142) and after 5 minutes (p =
0.0003) were statistically significantly lower in the patients with diabetes
compared to the healthy women. The women with type 2 and gestational diabetes
were statistically significantly older than those with type 1 diabetes (p =
0.001). A higher incidence of fetal macrosomia in the women with gestational
and type 2 diabetes compared to those with type 1 diabetes was at the
borderline of statistical significance (p = 0.07), whereas the incidence of
hypoglycemia of newborn was statistically significantly higher in the
patients with type 1 diabetes (p < 0.0001). Glycosylated hemoglobin (HbA1c)
levels were statistically significantly higher in the diabetic women giving
birth during and before the week of gestation 36 (p = 0.0087), but there were
no differences in HbA1c levels in regard to fetal macrosomia (p = 0.45) and
congenital abnormalities (p = 0.32). Conclusion. The results of our study
show a higher incidence of perinatal fetal morbidity (hypoglycemia, jaundice,
respiratory distress syndrome) in the patients with type 1, type 2 and
gestation diabetes than in the healthy controls. Also, we found a higher
incidence of cesarean section in the patients with type 1 diabetes than in
those with type 2, gestation diabetes and healthy controls. Although delivery
in the patients with type 1, type 2 and gestational diabetes was completed
approximately one to two weeks earlier compared to the healthy controls there
was no statistically significant difference in the incidence of preterm
delivery (? 36th week of gestation) between the women with diabetes and
healthy controls. Preterm delivery associated with poorer glycaemic control
reflected through higher values of HbA1c in third trimester. Risks from
adverse pregnancy outcomes may be reduced to minimum by adequate
preconception counseling of diabetic patients and early diagnosis of diabetes
in pregnancy, in order to achieve glycemic control during organogenesis and
within pregnancy and through the teamwork of endocrinologists, gynecologists
and pediatricians.