Vnitr Lek 2015, 61(2):101-105

Has the pregnancy outcome of women with pregestational diabetes mellitus improved in ten years?

Daniela Čechurová^1,*, Michal Krčma¹, Zdeněk Jankovec¹, Jiří Dort², Jan Turek³, Silvie Lacigová¹, Zdeněk Rušavý¹

¹ Diabetologické centrum I. interní kliniky LF UK a FN Plzeň, přednosta prof. MUDr. Martin Matějovič, Ph.D.

² Neonatologické oddělení FN Plzeň, primář doc. MUDr. Jiří Dort, Ph.D.

³ Gynekologicko-porodnická klinika LF UK a FN Plzeň, přednosta doc. MUDr. Zdeněk Novotný, CSc.

Introduction:
In spite of progress in medicine, studies from a number of countries indicate steadily increased risk of perinatal morbidity and mortality in the offspring of diabetic mothers. No data regarding the pregnancy outcome in women with diabetes mellitus type 1 and 2 (pregestational DM) have been published in the Czech Republic. The aim of the study was to evaluate the pregnancy course of women with pregestational DM and outcome of their offspring and to assess whether it has improved in ten years.

Methods:
A retrospective evaluation of pregnancy outcome of pregestational DM women followed up in the University Hospital Pilsen in years 2000-2009 (Group A, n = 107) and comparison with the period 1990-1997 (Group B, n = 39) were performed. Wilcoxon non-paired test, contingency tables, step-wise logistic regression and step-wise linear multiple regression methods were used for statistical analyses.

Results:
Data is presented as median (interquartile range). Women from the Group A were older 28 (25, 31) vs 25 (22, 27) years, p = 0.01. Otherwise, the groups did not statistically significantly differ in diabetes duration, BMI, and representation of women with type 2 diabetes. A better glycemic control (HbA_1c, mmol/mol) was achieved in the Group A in all trimesters - 1^st trimester: 59 (47, 67) vs 66 (56, 76), 2^nd trimester: 46 (40, 52) vs 54 (48, 59) and 3^rd trimester: 46 (40, 51) vs 53 (47, 60), p = 0.01. The caesarean section rate decreased (65.2 % vs 87.5 %, p < 0.05). The incidence of the respiratory distress syndrome after adjustment for age and diabetes duration also decreased (8.9 % vs 18.2 %, p < 0.05). A decreasing trend in the rate of premature delivery before 34^th week of gestation (1.1 % vs 6.3 %) and neonatal mortality (1.1 % vs 2.9 %) was observed, however, the differences were not statistically significant.

Conclusion:
The achieved improved glycemic control led to only a partial improvement in the course of pregnancy and outcome of the offspring of diabetic mothers.

Keywords: offspring of diabetic mother; pregestational diabetes; pregnancy; type 1 and type 2 diabetes mellitus

Received: July 27, 2014; Accepted: October 21, 2014; Published: February 1, 2015  Show citation