MAIN OBJECTIVES: The objective was to describe pre-gestational history and the maternal, fetal and neonatal outcome in pregnancies in women with pre-gestational type 2 diabetes during the period between 1992 and 2006 from one center in the Netherlands. METHODS: Patients attending the obstetric-diabetology outpatient clinic of a tertiary referral center were studied. This center also has a regular diabetes clinic and a community midwifery service. Patients were identified from the database. Maternal outcome (pre-eclampsia, pre-term delivery, Caesarean section) and fetal and neonatal outcome (macrosomia, congenital malformations, perinatal mortality, neonatal hypoglycemia) were analyzed as well HbA1c levels, planning of pregnancy, gestational age at first antenatal visit and ethnic background. RESULTS: Sixty-six singleton pregnancies from 48 women were analyzed. Their age was 34 +/- 5 yr, the BMI 31.7 +/- 7.4 and the median duration of diabetes was 3 yr. 52% were Caucasian and 35% were of Moroccan descent. 49% did not complete secondary school. Moroccan descent was associated with a lower educational level and a BMI comparable with the whole study group. The proportion of planned pregnancies was approximately 70%. The mean HbA1c in the first trimester was 6.4 +/- 1.1% and the gestational age at first visit was 10 +/- 5 wk, in one-quarter before 6 wk. The prevalences of variables related to maternal and neonatal outcome were as follows: spontaneous abortion 13.6%, pre-eclampsia 8.9%, pre-term delivery 21.4%, spontaneous labor 25.0%, induced labor 48.2%, Caesarean section 42.9%, macrosomia (>/=90th percentile) 41.1%, severe hypoglycemia 41.5% and major congenital malformations 5.1%. CONCLUSIONS: Pre-gestational type 2 diabetes is associated with an increased incidence of adverse pregnancy outcome despite reasonable mean HbA1c level and despite a high frequency of planned pregnancies. Many women report relatively late. Improvement in the outcome requires more active peri-gestational specialist care and a tailored approach is required towards migrant communities.
MAIN OBJECTIVES: The objective was to describe pre-gestational history and the maternal, fetal and neonatal outcome in pregnancies in women with pre-gestational type 2 diabetes during the period between 1992 and 2006 from one center in the Netherlands. METHODS:Patients attending the obstetric-diabetologyoutpatient clinic of a tertiary referral center were studied. This center also has a regular diabetes clinic and a community midwifery service. Patients were identified from the database. Maternal outcome (pre-eclampsia, pre-term delivery, Caesarean section) and fetal and neonatal outcome (macrosomia, congenital malformations, perinatal mortality, neonatal hypoglycemia) were analyzed as well HbA1c levels, planning of pregnancy, gestational age at first antenatal visit and ethnic background. RESULTS: Sixty-six singleton pregnancies from 48 women were analyzed. Their age was 34 +/- 5 yr, the BMI 31.7 +/- 7.4 and the median duration of diabetes was 3 yr. 52% were Caucasian and 35% were of Moroccan descent. 49% did not complete secondary school. Moroccan descent was associated with a lower educational level and a BMI comparable with the whole study group. The proportion of planned pregnancies was approximately 70%. The mean HbA1c in the first trimester was 6.4 +/- 1.1% and the gestational age at first visit was 10 +/- 5 wk, in one-quarter before 6 wk. The prevalences of variables related to maternal and neonatal outcome were as follows: spontaneous abortion 13.6%, pre-eclampsia 8.9%, pre-term delivery 21.4%, spontaneous labor 25.0%, induced labor 48.2%, Caesarean section 42.9%, macrosomia (>/=90th percentile) 41.1%, severe hypoglycemia 41.5% and major congenital malformations 5.1%. CONCLUSIONS: Pre-gestational type 2 diabetes is associated with an increased incidence of adverse pregnancy outcome despite reasonable mean HbA1c level and despite a high frequency of planned pregnancies. Many women report relatively late. Improvement in the outcome requires more active peri-gestational specialist care and a tailored approach is required towards migrant communities.
Authors: Tine D Clausen; Elisabeth Mathiesen; Pia Ekbom; Ellinor Hellmuth; Thomas Mandrup-Poulsen; Peter Damm Journal: Diabetes Care Date: 2005-02 Impact factor: 19.112
Authors: Dorte M Jensen; Peter Damm; Lars Moelsted-Pedersen; Per Ovesen; Jes G Westergaard; Margrethe Moeller; Henning Beck-Nielsen Journal: Diabetes Care Date: 2004-12 Impact factor: 19.112
Authors: Pierre Boulot; Nathalie Chabbert-Buffet; Claude d'Ercole; Michele Floriot; Pierre Fontaine; Alain Fournier; Jean Yves Gillet; Henri Gin; Sylvie Grandperret-Vauthier; Ann Marie Geudj; Brigette Guionnet; Sylvie Hauguel-de-Mouzon; Sylvie Hieronimus; Mederic Hoffet; Dominique Jullien; Marie Françoise Lamotte; Veronique Lejeune; Jacques Lepercq; Françoise Lorenzi; Pierre Mares; Alain Miton; Alfred Penfornis; Brigitte Pfister; Eric Renard; Michel Rodier; Philippe Roth; Guy-Alain Sery; José Timsit; Anne Sylvie Valat; Anne Vambergue; Odile Verier-Mine Journal: Diabetes Care Date: 2003-11 Impact factor: 19.112
Authors: Katarzyna Cyganek; Alicja Hebda-Szydlo; Jan Skupien; Barbara Katra; Izabela Janas; Alicja Borodako; Irena Kaim; Tomasz Klupa; Alfred Reron; Maciej T Malecki Journal: Endocrine Date: 2011-04-29 Impact factor: 3.633
Authors: Maarten Rijpert; Inge M Evers; Monique A M J de Vroede; Harold W de Valk; Cobi J Heijnen; Gerard H A Visser Journal: Diabetes Care Date: 2009-08-03 Impact factor: 19.112