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Outcomes of pregnancy in insulin dependent diabetic women: results of a five year population cohort study

^a Broadgreen Hospital, Liverpool L14 3LD, ^b School of Biological Sciences, University of Liverpool, Liverpool L69 38X, ^c Fetal and Infant Pathology, University of Liverpool, Liverpool L69 3BX, ^d Department of Public Health, University of Liverpool, Whelan Building, Liverpool L69 3GB, ^e Liverpool Women's Hospital, Liverpool L8 7SS

Correspondence to: Dr Platt mjplatt@liv.ac.uk

Objective: To monitor pregnancies in women with pre-existent insulin dependent diabetes for pregnancy loss, congenital malformations, and fetal growth in a geographically defined area of north west England.
Design: Population cohort study.
Setting: 10 maternity units in Cheshire, Lancashire, and Merseyside which had no regional guidelines for the management of pregnancy in diabetic women.
Subjects: 462 pregnancies in 355 women with insulin dependent diabetes from the 10 centres over five years (1990-4 inclusive).
Main outcome measures: Numbers and rates of miscarriages, stillbirths, and neonatal and postneonatal deaths; prevalence of congenital malformations; birth weight in relation to gestational age.
Results: Among 462 pregnancies, 351 (76%) resulted in a liveborn infant, 78 (17%) aborted spontaneously, nine (2%) resulted in stillbirth, and 24 (5%) were terminated. Of the terminations, nine were for congenital malformation. The stillbirth rate was 25.0/1000 total births (95% confidence interval 8.9 to 41.1) compared with a population rate of 5.0/1000, and infant mortality was 19.9/1000 live births (5.3 to 34.6) compared with 6.8/1000. The prevalence of congenital malformations was 94.0/1000 live births (63.5 to 124.5) compared with 9.7/1000 in the general population. When corrected for gestational age, mean birth weight in the sample was 1.3 standard deviations greater than that of infants of non-diabetic mothers. Infants with congenital malformations weighed less than those without.
Conclusion: In an unselected population the infants of women with pre-existent insulin dependent diabetes mellitus have a 10-fold greater risk of a congenital malformation and a fivefold greater risk of being stillborn than infants in the general population. Further improvements in the management of pregnancy in diabetic women are needed if target of the St Vincent declaration of 1989 is to be met.

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• Ullmo, S., Vial, Y., Di Bernardo, S., Roth-Kleiner, M., Mivelaz, Y., Sekarski, N., Ruiz, J., Meijboom, E. J (2007). Pathologic ventricular hypertrophy in the offspring of diabetic mothers: a retrospective study. Eur Heart J 28: 1319-1325 [Abstract] [Full text]  
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• Mathiesen, E. R., Kinsley, B., Amiel, S. A., Heller, S., McCance, D., Duran, S., Bellaire, S., Raben, A., on behalf of the Insulin Aspart Pregnancy Study Gr, (2007). Maternal Glycemic Control and Hypoglycemia in Type 1 Diabetic Pregnancy: A randomized trial of insulin aspart versus human insulin in 322 pregnant women. Diabetes Care 30: 771-776 [Abstract] [Full text]  
• PADMANABHAN, R., MOHAMED, S., SINGH, S. (2006). Beneficial Effect of Supplemental Lipoic Acid on Diabetes-Induced Pregnancy Loss in the Mouse. Ann. N. Y. Acad. Sci. 1084: 118-131 [Abstract] [Full text]  
• Yang, J., Cummings, E. A., O'Connell, C., Jangaard, K. (2006). Fetal and neonatal outcomes of diabetic pregnancies.. Obstet Gynecol 108: 644-650 [Abstract] [Full text]  
• Gardiner, H M, Pasquini, L, Wolfenden, J, Kulinskaya, E, Li, W, Henein, M (2006). Increased periconceptual maternal glycated haemoglobin in diabetic mothers reduces fetal long axis cardiac function. Heart 92: 1125-1130 [Abstract] [Full text]  
• Macintosh, M. C M, Fleming, K. M, Bailey, J. A, Doyle, P., Modder, J., Acolet, D., Golightly, S., Miller, A. (2006). Perinatal mortality and congenital anomalies in babies of women with type 1 or type 2 diabetes in England, Wales, and Northern Ireland: population based study. BMJ 333: 177- [Abstract] [Full text]  
• Johnstone, F. D., Lindsay, R. S., Steel, J. (2006). Type 1 diabetes and pregnancy: trends in birth weight over 40 years at a single clinic.. Obstet Gynecol 107: 1297-1302 [Abstract] [Full text]  
• Riley, J. K, Moley, K. H (2006). Glucose utilization and the PI3-K pathway: mechanisms for cell survival in preimplantation embryos.. Reproduction 131: 823-835 [Abstract] [Full text]  
• Jensen, D. M., Damm, P., Moelsted-Pedersen, L., Ovesen, P., Westergaard, J. G., Moeller, M., Beck-Nielsen, H. (2004). Outcomes in Type 1 Diabetic Pregnancies: A nationwide, population-based study. Diabetes Care 27: 2819-2823 [Abstract] [Full text]  
• Ray, J.G., Vermeulen, M.J., Meier, C., Wyatt, P.R. (2004). Risk of congenital anomalies detected during antenatal serum screening in women with pregestational diabetes. QJM 97: 651-653 [Abstract] [Full text]  
• Evers, I. M, de Valk, H. W, Visser, G. H A (2004). Risk of complications of pregnancy in women with type 1 diabetes: nationwide prospective study in the Netherlands. BMJ 328: 915- [Abstract] [Full text]  
• Endres, L. K., Sharp, L. K., Haney, E., Dooley, S. L. (2004). Health Literacy and Pregnancy Preparedness in Pregestational Diabetes. Diabetes Care 27: 331-334 [Abstract] [Full text]  
• Weindling, A M (2003). The confidential enquiry into maternal and child health (CEMACH). Arch. Dis. Child. 88: 1034-1037 [Full text]  
• Diabetes and Pregnancy Group, France, (2003). French Multicentric Survey of Outcome of Pregnancy in Women With Pregestational Diabetes. Diabetes Care 26: 2990-2993 [Abstract] [Full text]  
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• Temple, R., Aldridge, V., Greenwood, R., Heyburn, P., Sampson, M., Stanley, K. (2002). Association between outcome of pregnancy and glycaemic control in early pregnancy in type 1 diabetes: population based study. BMJ 325: 1275-1276 [Full text]  
• Bloomgarden, Z. T. (2002). Neuropathy, Womens' Health, and Socioeconomic Aspects of Diabetes. Diabetes Care 25: 1085-1094 [Full text]  
• Ray, J.G., O'brien, T.E., Chan, W.S. (2001). Preconception care and the risk of congenital anomalies in the offspring of women with diabetes mellitus: a meta-analysis. QJM 94: 435-444 [Abstract] [Full text]  
• Dorman, J. S., Steenkiste, A. R., Foley, T. P., Strotmeyer, E. S., Burke, J. P., Kuller, L. H., Kwoh, C. K. (2001). Menopause in Type 1 Diabetic Women: Is it Premature?. Diabetes 50: 1857-1862 [Abstract] [Full text]  
• Bhattacharyya, A., Brown, S., Hughes, S., Vice, P.A. (2001). Insulin lispro and regular insulin in pregnancy. QJM 94: 255-260 [Abstract] [Full text]  
• Heneghan, M A, Norris, S M, O'Grady, J G, Harrison, P M, McFarlane, I G (2001). Management and outcome of pregnancy in autoimmune hepatitis. Gut 48: 97-102 [Abstract] [Full text]  
• Dunne, F.P., Brydon, P.A., Proffitt, M., Smith, T., Gee, H., Holder, R.L. (2000). Fetal and maternal outcomes in Indo-Asian compared to Caucasian women with diabetes in pregnancy. QJM 93: 813-818 [Abstract] [Full text]  
• Hawthorne, G, Irgens, L M, Lie, R T (2000). Outcome of pregnancy in diabetic women in northeast England and in Norway, 1994-7. BMJ 321: 730-731 [Full text]  
• McAnulty, G. R., Robertshaw, H. J., Hall, G. M. (2000). Anaesthetic management of patients with diabetes mellitus. Br J Anaesth 85: 80-90 [Full text]  
• Dunne, F.P., Chowdhury, T.A., Hartland, A, Smith, T., Brydon, P.A., McConkey, C., Nicholson, H.O. (1999). Pregnancy outcome in women with insulin-dependent diabetes mellitus complicated by nephropathy. QJM 92: 451-454 [Abstract] [Full text]  
• Watkins, P J, Thomas, P K (1998). Diabetes mellitus and the nervous system. J. Neurol. Neurosurg. Psychiatry 65: 620-632 [Full text]  
• Hadden, D., Traub, A., Lowy, C., Nielsen, G. L., Sørensen, H. T., Olsen, J., Nielsen, P. H., Sabroe, S., Rogerson, L., Bancroft, K., Casson, I F, Clarke, C A, Stanisstreet, M, Howard, C V, McKendrick, O, Pennycook, S, van Velzen, D, Pharoah, P O D, Platt, M J, Walkinshaw, S (1998). Outcome of pregnancy in women with insulin dependent diabetes. BMJ 316: 550-550 [Full text]  
• (1997). PREGNANCY OUTCOME IN DIABETIC WOMEN. JWatch General 1997: 8-8 [Full text]