Poster Presentation Australasian Diabetes in Pregnancy Society and Society of Obstetric Medicine Australia and New Zealand Joint Scientific Meeting 2021

Impact of pre-gestational type 1 and 2 diabetes and obesity on perinatal outcomes: a 10-year retrospective cohort study (#97)

Jinghang Luo 1 , Jean Lu 1 , Ryan Endall 1 , Rebecca Foskey 1 , Danielle Hulse 2 , Rachel Frederick 2 , Christopher J Yates 1 2 , Dev Kevat 1 , Shane S Hamblin 1 2 , Joanne Said 3 4 , Glyn Teale 3 , I-Lynn Lee 1 2
  1. Endocrinology and Diabetes, Western Health, Melbourne, VIC, Australia
  2. Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
  3. Women's and Children's Division, Western Health, Melbourne, VIC, Australia
  4. Department of Obstetrics and Gynaecology, University of Melbourne, MELBOURNE, Victoria, Australia

BACKGROUND

Prevalence of pre-gestational type 2 diabetes mellitus (T2DM) is increasing due to increasing obesity rates, sedentary lifestyle and later child-bearing ages. We compared the perinatal outcomes of women with T2DM or type 1 diabetes mellitus (T1DM) to women without diabetes.

METHODS
A retrospective cohort study was conducted for all singleton births >20 weeks’ gestation at Western Health in Melbourne, Australia from 2010-2019 including women with pre-gestational diabetes and without diabetes.  The control group comprised of 2 consecutive women who birthed before and after each index T1DM or T2DM case.  Antenatal and birth outcomes were extracted from Birth Outcomes Systems database.  Analysis using t-tests, chi-squared, univariate and multivariate logistic regression were performed.

RESULTS
Women with T2DM (n=317) were older (T2DM vs. T1DM vs. control, 33.4 vs 29.7 vs 29.5 years, p<0.001), heavier (body mass index [BMI] 34.5 vs 26.8 and 25.4 kg/m2, p<0.001), and more likely to be multiparous (75.4% vs 55.4% and 61.1%, p<0.001). When compared to their T1DM counterparts (n=92), those with T2DM had lower earliest and latest HbA1c levels (6.6% vs 7.8%, p<0.001 and 5.9% vs 6.9%, p<0.001).

Women with T2DM and T1DM compared to controls were more likely to have a large for gestational age (LGA) baby [T2DM: aOR (95%CI): 2.64 (1.82–3.82), (T1DM: 5.14 (3.01–8.79)], neonatal hypoglycaemia [T2DM: 9.32(5.96–16.2), T1DM: 27.7(15.6–49.3)], primary caesarean section [T2DM: 1.93 (1.43–2.61), T1DM 1.98 (1.17–3.34)] and perinatal death [T2DM: 17.5 (5.2–59.6), T1DM: 12.1 (2.1–67.0)] after adjusting for BMI. BMI was a significant contributor to LGA and neonatal hypoglycaemia outcomes.

CONCLUSION

Despite advancing technologies to improve glycaemic control, there is still a disparity in perinatal outcomes between women with T1DM and T2DM compared to women without diabetes.  Further studies are required to examine factors contributing to higher perinatal mortality in women with pre-gestational diabetes.