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Prospective population based survey of outcome of pregnancy in diabetic women: results of the Northern Diabetic Pregnancy Audit, 1994

BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7103.279 (Published 02 August 1997) Cite this as: BMJ 1997;315:279
  1. Gillian Hawthorne, consultant physiciana,
  2. S Robson, professor of fetal medicineb,
  3. E A Ryall, consultant obstetricianc,
  4. D Sen, research midwifed,
  5. S H Roberts, consultant physiciand,
  6. M P Ward Platt, consultant paediatrician on behalf of the Northern Diabetic Pregnancy Audite
  1. a Hartlepool General Hospital, Hartlepool TS24 9AH
  2. b University of Newcastle upon Tyne, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP
  3. c North Tees General Hospital, Hardwick, Stockton on Tees TS19 8PE
  4. d Diabetes Resource Centre, North Tyneside Hospital, North Shields, Tyne and Wear NE29 8NH
  5. e Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP
  1. Correspondence to: Dr Hawthorne
  • Accepted 19 May 1997

Abstract

Objective: To determine whether the St Vincent declaration (1989) target of diabetic pregnancy outcome approximating non-diabetic pregnancy outcome is near to being achieved.

Design: Prospective collection of population based information on pregnancies in women with diabetes from all participating hospitals.

Setting: District general and teaching hospitals of the former Northern region.

Subjects: 111 diabetic women booking with pregnancy during 1 January to 31 December 1994.

Main outcome measures: Diabetic control, perinatal mortality rate, fetal abnormality rate.

Results: The perinatal mortality rate was 48/1000 for diabetic pregnancies compared with 8.9/1000 for the background population (odds ratio 5.38; 95% confidence interval 2.27 to 12.70) and the neonatal mortality rate was 59/1000 compared with 3.9/1000 (15.0; 6.77 to 33.10). Two late neonatal deaths were due to congenital heart defects. Six per cent of all fetal losses (6/109 cases) were due to major malformations. The congenital malformation rate was 83/1000 compared with 21.3/1000 (3.76; 2.00 to 7.06) in the background population.

Conclusion: Diabetic pregnancy remains a high risk state with perinatal mortality and fetal malformation rates much higher than in the background population.

Key messages

  • Though diabetic women who plan their pregnancies receive prepregnancy advice, most have poor diabetic control at conception

  • In diabetic pregnancies the perinatal mortality rate is five times higher, the neonatal mortality rate 15 times higher, and the congenital malformation rate four times higher than in the background population

  • There is a substantial excess of premature births in diabetic pregnancies

  • The outcome of diabetic pregnancy remains poor; better uptake of preconceptional care may improve outcome

Footnotes

    • Accepted 19 May 1997
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