BMJ  2006;333:177 (22 July), doi:10.1136/bmj.38856.692986.AE (published 16 June 2006)

Research

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

Mary C M Macintosh, medical director1, Kate M Fleming, senior data analyst1, Jaron A Bailey, health research data analyst1, Pat Doyle, reader in epidemiology2, Jo Modder, obstetric lead1, Dominique Acolet, neonatal lead1, Shona Golightly, director of research and development1, Alison Miller, programme director1

1 Confidential Enquiry into Maternal and Child Health, London NW1 5SD, 2 London School of Hygiene and Tropical Medicine, London WC1E 7HT

Correspondence to: M Macintosh mary.macintosh{at}hpa.org.uk

Abstract

Objective To provide perinatal mortality and congenital anomaly rates for babies born to women with type 1 or type 2 diabetes in England, Wales, and Northern Ireland.

Design National population based pregnancy cohort.

Setting 231 maternity units in England, Wales, and Northern Ireland.

Participants 2359 pregnancies to women with type 1 or type 2 diabetes who delivered between 1 March 2002 and 28 February 2003.

Main outcome measures Stillbirth rates; perinatal and neonatal mortality; prevalence of congenital anomalies.

Results Of 2359 women with diabetes, 652 had type 2 diabetes and 1707 had type 1 diabetes. Women with type 2 diabetes were more likely to come from a Black, Asian, or other ethnic minority group (type 2, 48.8%; type 1, 9.1%) and from a deprived area (type 2, 46.3% in most deprived fifth; type 1, 22.8%). Perinatal mortality in babies of women with diabetes was 31.8/1000 births. Perinatal mortality was comparable in babies of women with type 1 (31.7/1000 births) and type 2 diabetes (32.3/1000) and was nearly four times higher than that in the general maternity population. 141 major congenital anomalies were confirmed in 109 offspring. The prevalence of major congenital anomaly was 46/1000 births in women with diabetes (48/1000 births for type 1 diabetes; 43/1000 for type 2 diabetes), more than double that expected. This increase was driven by anomalies of the nervous system, notably neural tube defects (4.2-fold), and congenital heart disease (3.4-fold). Anomalies in 71/109 (65%) offspring were diagnosed antenatally. Congenital heart disease was diagnosed antenatally in 23/42 (54.8%) offspring; anomalies other than congenital heart disease were diagnosed antenatally in 48/67 (71.6%) offspring.

Conclusion Perinatal mortality and prevalence of congenital anomalies are high in the babies of women with type 1 or type 2 diabetes. The rates do not seem to differ between the two types of diabetes.


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Rapid Responses:

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Continued poor outcomes in diabetic pregnancy
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bmj.com, 4 Jul 2006 [Full text]
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