Intended for healthcare professionals


Risk of complications of pregnancy in women with type 1 diabetes: nationwide prospective study in the Netherlands

BMJ 2004; 328 doi: (Published 15 April 2004) Cite this as: BMJ 2004;328:915
  1. Inge M Evers (ingwil{at}, registrar1,
  2. Harold W de Valk, consultant2,
  3. Gerard H A Visser, professor of obstetrics1
  1. 1Department of Obstetrics, University Medical Center Utrecht, PO Box 85090, 3508 AB, Utrecht, Netherlands
  2. 2Department of Internal Medicine and Endocrinology, University Medical Center Utrecht
  1. Correspondence to: I M Evers
  • Accepted 18 February 2004


Objective To investigate maternal, perinatal, and neonatal outcomes of pregnancies in women with type 1 diabetes in the Netherlands.

Design Nationwide prospective cohort study.

Setting All 118 hospitals in the Netherlands.

Participants 323 women with type 1 diabetes who became pregnant between 1 April 1999 and 1 April 2000.

Main outcome measures Maternal, perinatal, and neonatal outcomes of pregnancy.

Results 84% (n = 271) of the pregnancies were planned. Glycaemic control early in pregnancy was good in most women (HbA1c  7.0% in 75% (n = 212) of the population), and folic acid supplementation was adequate in 70% (n = 226). 314 pregnancies that went beyond 24 weeks' gestation resulted in 324 infants. The rates of pre-eclampsia (40; 12.7%), preterm delivery (101; 32.2%), caesarean section (139; 44.3%), maternal mortality (2; 0.6%), congenital malformations (29; 8.8%), perinatal mortality (9; 2.8%), and macrosomia (146; 45.1%) were considerably higher than in the general population. Neonatal morbidity (one or more complications) was extremely high (260; 80.2%). The incidence of major congenital malformations was significantly lower in planned pregnancies than in unplanned pregnancies (4.2% (n = 11) v 12.2% (n = 6); relative risk 0.34, 95% confidence interval 0.13 to 0.88).

Conclusion Despite a high frequency of planned pregnancies, resulting in overall good glycaemic control (early) in pregnancy and a high rate of adequate use of folic acid, maternal and perinatal complications were still increased in women with type 1 diabetes. Neonatal morbidity, especially hypoglycaemia, was also extremely high. Near optimal maternal glycaemic control (HbA1c  7.0%) apparently is not good enough.


  • Contributors All authors conceived and designed the study, drafted the manuscript, and approved the final manuscript. IME analysed and interpreted the data. HWdV and GHAV interpreted the data. GHAV will act as guarantor for the paper.

  • Funding Novo Nordisk Farma BV, Alphen aan De Rijn, the Netherlands

  • Competing interests None declared

  • Ethical approval The study was approved by the medical ethics committee of the University Medical Center Utrecht

  • Accepted 18 February 2004
View Full Text