Background/Aims: To explore the demographics, management and complications experienced by women with pre-existing Type 2 Diabetes Mellitus (T2DM) during pregnancy over a 20-year period.
Methods: A retrospective review of all pregnancies (n=555) of women with T2DM (n=418) who received antenatal care at Royal Women’s Hospital between 2000-2019 inclusive. Data were recorded in the Diabetes in Pregnancy database, exported to excel and analysed using SPSS.
Results: Over 20 years there were 555 pregnancies in 418 women with 534 pregnancies progressing beyond 20 weeks’ gestation. Maternal age increased, with the average age of pregnancy being 34 [SD+/- 9.4] years. The average BMI at initial antenatal visit was 33kg/m2. Pre-eclampsia complicated 62 pregnancies (12%), with the incidence of pre-eclampsia increasing over the 20-year time period. Antenatal aspirin and folate use increased, with aspirin rising from 11% in 2000-2004 to 47% in 2015-2019, and antenatal folate use increasing from 43% to 74% over the same period.
Of the 534 continuing pregnancies there were 14 stillbirths and three neonatal deaths. Fifty-nine percent of deliveries were by caesarean section. Preterm delivery occurred in 133 (25%) pregnancies. The rate of SCN admission decreased over the 20-year period from 64% to 37%. Congenital malformations occurred in 53 pregnancies (10%).
Mean HbA1c decreased over the course of pregnancy (1st trimester = 7.42%, 2nd trimester = 6.4%, 3rd trimester = 5.9%), there was no difference in HbA1c over the time periods. Eighteen percent of women attended the pre-pregnancy clinic, these women had an average first trimester HbA1c of 7.0%. Antenatal metformin use increased.
Conclusions: Pregnancy in women with T2DM continues to be associated with significant complications for both women and their neonates. Despite increased use of metformin, aspirin and folate some pregnancy outcomes have not discernibly improved. Emphasis should be placed on the availability of effective pre-pregnancy care.