open access

Vol 6, No 6 (2005): Practical Diabetology
Original articles (submitted)
Published online: 2005-11-03
Get Citation

The course of pregnancy in patients with type 2 diabetes mellitus as compared with type 1 diabetes

Elżbieta Kozek, Jacek Sieradzki, Alicja Hebda-Szydło, Aneta Sułkowska, Joanna Wójcik, Katarzyna Cyganek, Irena Kaim
Diabetologia Praktyczna 2005;6(6):299-306.

open access

Vol 6, No 6 (2005): Practical Diabetology
Original articles (submitted)
Published online: 2005-11-03

Abstract

INTRODUCTION. The increasing prevalence of type 2 diabetes mellitus in the increasingly younger age groups is observed also in women in the reproductive age. Consequently, the number of pregnant women with type 2 diabetes is also increased. Aim of the study was to compare diabetes normalization, course of pregnancy and delivery in patients with type 2 (DM2) and type 1 diabetes mellitus (DM1).
MATERIAL AND METHODS: 24 patients with prepregnancy DM2 and for comparison 110 women with DM1 treated in the Department of Metabolic Diseases and the Department of Pathological Pregnancy were analyzed retrospectively with respect to clinical data, diabetes normalization, blood pressure, weight gain in each trimester, and data on delivery and neonates.
RESULTS. Patients with DM2 as compared with DM1 patients referred for specialized care in the later stages of pregnancy (18.9 ± 8.0 vs. 10.3 ± 5.5, p < 0.001), were older (30-48 years in DM2 and 19-45 years in DM1, p < 0,001), had higher body mass index (33.8 ± 5.3 vs. 26.2 ± 3.1, p < 0.001), and a larger number of pregnancies (2.8 ± 1.2 vs. 1.9 ± 1.3, p < 0.01). In women with DM2 cholesterol and triglyceride levels were significantly higher than in women with DM1 (5.1 ± 1.7 vs. 3.9 ± 0.6 mmol/l, p < 0.001 and 2.6 ± 2.2 vs. 0.9 ± 0.5 mmol/l, p < 0.001). Women with DM2 had higher systolic blood pressure on admission and in the second trimester (130 ± 16 vs. 117 ± 10 mm Hg, p < 0.05 and 123 ± 12 vs. 109 ± 10 mm Hg, p < 0.01). There were no significant differences in diabetes normalization between DM2 and DM1 on admission and in trimester 2 and 3. However, both in DM2 and DM1 HbA1c levels on admission were significantly higher than in trimester 2 and 3 (6.4 ± 1.3 vs. 5.9 ± 0.6 and 5.7 ± 0,6%, p < 0.05 and 7,2 ± 1.5 vs. 5.9 ± 0.9 and 5.9 ± 0.8%, p < 0.05). In DM2 patients as many as 25% of neonates had birth weight exceeding 4000 g. After adjustment for birth weight and maternal age in DM2 there were 33.3% of neonates with birth weight > 90th percentile and 16.6% with birth weight < 10th percentile. In DM2 women perinatal mortality was 4.5-fold higher and lethal congenital defect rate was also 4-fold higher.
CONCLUSIONS. Specialized diabetological and obstetrical care in women with DM1 and DM2 affects normalization of diabetes. The present findings indicate also higher perinatal mortality and congenital defect rates in DM2. This may be a result of late referral for specialist care and no planning for pregnancy by DM2 women, and the presence of other risk factors such as age and obesity.

Abstract

INTRODUCTION. The increasing prevalence of type 2 diabetes mellitus in the increasingly younger age groups is observed also in women in the reproductive age. Consequently, the number of pregnant women with type 2 diabetes is also increased. Aim of the study was to compare diabetes normalization, course of pregnancy and delivery in patients with type 2 (DM2) and type 1 diabetes mellitus (DM1).
MATERIAL AND METHODS: 24 patients with prepregnancy DM2 and for comparison 110 women with DM1 treated in the Department of Metabolic Diseases and the Department of Pathological Pregnancy were analyzed retrospectively with respect to clinical data, diabetes normalization, blood pressure, weight gain in each trimester, and data on delivery and neonates.
RESULTS. Patients with DM2 as compared with DM1 patients referred for specialized care in the later stages of pregnancy (18.9 ± 8.0 vs. 10.3 ± 5.5, p < 0.001), were older (30-48 years in DM2 and 19-45 years in DM1, p < 0,001), had higher body mass index (33.8 ± 5.3 vs. 26.2 ± 3.1, p < 0.001), and a larger number of pregnancies (2.8 ± 1.2 vs. 1.9 ± 1.3, p < 0.01). In women with DM2 cholesterol and triglyceride levels were significantly higher than in women with DM1 (5.1 ± 1.7 vs. 3.9 ± 0.6 mmol/l, p < 0.001 and 2.6 ± 2.2 vs. 0.9 ± 0.5 mmol/l, p < 0.001). Women with DM2 had higher systolic blood pressure on admission and in the second trimester (130 ± 16 vs. 117 ± 10 mm Hg, p < 0.05 and 123 ± 12 vs. 109 ± 10 mm Hg, p < 0.01). There were no significant differences in diabetes normalization between DM2 and DM1 on admission and in trimester 2 and 3. However, both in DM2 and DM1 HbA1c levels on admission were significantly higher than in trimester 2 and 3 (6.4 ± 1.3 vs. 5.9 ± 0.6 and 5.7 ± 0,6%, p < 0.05 and 7,2 ± 1.5 vs. 5.9 ± 0.9 and 5.9 ± 0.8%, p < 0.05). In DM2 patients as many as 25% of neonates had birth weight exceeding 4000 g. After adjustment for birth weight and maternal age in DM2 there were 33.3% of neonates with birth weight > 90th percentile and 16.6% with birth weight < 10th percentile. In DM2 women perinatal mortality was 4.5-fold higher and lethal congenital defect rate was also 4-fold higher.
CONCLUSIONS. Specialized diabetological and obstetrical care in women with DM1 and DM2 affects normalization of diabetes. The present findings indicate also higher perinatal mortality and congenital defect rates in DM2. This may be a result of late referral for specialist care and no planning for pregnancy by DM2 women, and the presence of other risk factors such as age and obesity.
Get Citation

Keywords

type 1 diabetes; type 2 diabetes; pregnancy; perinatal mortality; congenital defects

About this article
Title

The course of pregnancy in patients with type 2 diabetes mellitus as compared with type 1 diabetes

Journal

Clinical Diabetology

Issue

Vol 6, No 6 (2005): Practical Diabetology

Pages

299-306

Published online

2005-11-03

Bibliographic record

Diabetologia Praktyczna 2005;6(6):299-306.

Keywords

type 1 diabetes
type 2 diabetes
pregnancy
perinatal mortality
congenital defects

Authors

Elżbieta Kozek
Jacek Sieradzki
Alicja Hebda-Szydło
Aneta Sułkowska
Joanna Wójcik
Katarzyna Cyganek
Irena Kaim

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

Czasopismo Diabetologia Kliniczna dostęne jest również w Ikamed - księgarnia medyczna

Wydawcą serwisu jest  "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl