In pregnant women with diabetes, maternal BMI (body mass
index) and blood sugar levels found to be critical determinants in increasing
risk of stillbirths, according to a recent study at the Institute of
Cardiovascular and Medical Sciences, University of Glasgow, UK.
Stillbirth refers to the birth of a baby at or
beyond 24 weeks of gestation, with no signs of life or breathing after delivery.
The
findings of the study appear in
Diabetologia, which is the journal of the European
Association for the Study of Diabetes.
Why is it Necessary to Determine Stillbirth
Risk Factors in Pregnant Diabetics?
- Women diagnosed
with diabetes before pregnancy have four
to fivefold higher risk of stillbirths and the risk has not reduced, while the incidence of stillbirths in general population (normal women)
has decreased over time
- Traditional risk factors of
stillbirths such as smoking, maternal obesity, and advanced
maternal outlined in the general population remain poorly characterized
for diabetes in pregnancy
- The study was thus undertaken to characterize maternal and fetal
risk factors that increase the risk of
stillbirths in pregnant diabetic women so that
appropriate interventions can be put in place to reduce this risk
Determining Key Factors that Increase Risk of
Stillbirths in Diabetic Mothers
- The study analyzed data from the
Scottish Morbidity Record 02 on babies delivered at or after 24 weeks from
April 1998 to June 2016 linked to data from Scottish Care
Information-Diabetes that includes women diagnosed with type 1 and type 2
diabetes before delivery
- The team analyzed possible risk
factors included glycated hemoglobin (HbA1c) before and during
pregnancy, maternal BMI from antenatal and diabetic check-ups, baby weight
as well as factors such as hospital size and geographical location that
could influence clinical care
- The study included 5392 single
births delivered by 3847 women having diabetes (3778 babies delivered by
2582 women with type 1 diabetes; and 1614 babies born to 1265 women with
type 2 diabetes)
- Rates of stillbirths were 16.1 per 1000
births in women with type 1 diabetes and 22.9 per 1000 births in women
with type 2 diabetes, in comparison to 4.9 per 1,000
births in the general population
- Type 1 diabetic women who had
stillbirths were found to have larger average blood sugar levels during
all stages of the pregnancy
- In contrast, for type 2 diabetic
women, pre-pregnancy blood sugar levels rather than levels during
pregnancy was the key factor in increasing risk of stillbirths
- Maternal
BMI was noted to be another independent risk
factor for stillbirth in pregnant women with diabetes
- With regards to fetal factors, in
women with type 1 diabetes, small for date babies had
a higher risk of stillbirth
- For type 2 diabetic women, large for
date babies increased risk of stillbirths
- Distribution of maternal age, smoking history, and number of
prior pregnancies were similar in women regardless of whether the pregnancy
ended in live birth or stillbirth
- Interestingly,
geographical location and hospital size did not influence the rates of
stillbirth suggesting that differences in clinical care did not affect
stillbirth risk
The
findings of the study thus suggest that maternal BMI (
body mass index) and blood glucose levels are the
biggest modifiable factors that increase the risk of stillbirths in pregnant women with
diabetes.
Stillbirth Risk in Male vs Female Fetuses
- Interestingly, in
the study, a large proportion of stillborn infants (81%) were boys in
mothers with type 2 diabetes
- The study found stillbirth rates
four-fold higher in male compared to female fetuses, in women with type 2
diabetes
- Previous studies have found that
male fetuses have increased risk of stillbirth by about 10% compared to
female fetuses.
- However, the team caution that
larger studies in different populations are needed to validate these
findings
Takeaways
From the Study - Reducing
Stillbirth Risk
- Pre-pregnancy
counseling and support to help women with type 1 and type 2 diabetes
achieve optimal blood sugar control
- Educating
diabetic women planning a pregnancy about the importance of achieving
optimal weight to reduce the risk of
complications including stillbirth
- Planning earlier
delivery in diabetic mothers and babies at risk
The
authors add, "However, because of potential issues with early delivery
-including
respiratory distress
syndrome as a result of inadequate lung development - we suggest that
the increased risk of neonatal morbidity needs to be more formally explored
before recommendations for optimal timing of delivery are made, particularly
where mothers are managing to obtain almost normal blood glucose levels."
‘Women with diabetes even before pregnancy have four to fivefold higher risk of stillbirths. Nearly a third of stillbirths occur near term (after 37 weeks) and planning early delivery may be beneficial.’
Read More..
In summary, the study conducted over 18 years and including
nearly 5000 infants finds that diabetic women with high BMI and blood sugar
levels have increased risk of stillbirths and addressing these issues before
pregnancy can reduce the risk.
Reference : - Factors associated with stillbirth in women with diabetes - (https://doi.org/10.1007/s00125-019-4943-9)
Source: Medindia