Perinatal mortality and congenital anomalies in babies of women with type 1 or type 2 diabetes in England, Wales, and Northern Ireland: population based studyBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.38856.692986.AE (Published 20 July 2006) Cite this as: BMJ 2006;333:177
- 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
- Accepted 14 April 2006
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.
Two extra tables are on bmj.com
We thank all the health professionals who were involved in the data collection at unit level; CEMACH regional managers and assistants for collecting and validating the data; Marjorie Renwick of the Northern Regional Maternity Survey Office for reviewing and coding all the suspected anomalies; EUROCAT for providing age specific congenital anomalies rates; and members of the CEMACH Diabetes Professional Advisory Group for their continued advice and guidance.
Contributors MCMM, KMF, and JAB developed the idea for the paper and drafted the paper. MCMM and JM designed the study. JAB, KMF, and PD did the statistical analysis. AM and SG were involved in collecting the data. DA categorised the cardiac anomalies. PD, JM, DA, SG, and AM advised on interpretation of the results. All authors revised the paper critically and approved the final manuscript. MCMM is the guarantor.
Funding CEMACH was funded by the National Institute for Clinical Excellence until 31 March 2005, by the National Patient Safety Agency from 1 April 2005, and by the Department of Health, Social Services and Public Safety of Northern Ireland.
Competing interests None declared.
Ethical approval As this programme was part of a national clinical audit, ethical approval and consent were not specifically sought. CEMACH obtained section 60 approval (under the Health and Social Care Act) for its programmes in December 2003.