Vol 6, No 6 (2005): Practical Diabetology
Research paper
Published online: 2005-11-03
The course of pregnancy in patients with type 2 diabetes mellitus as compared with type 1 diabetes
Diabetologia Praktyczna 2005;6(6):299-306.
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.
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.
Keywords: type 1 diabetestype 2 diabetespregnancyperinatal mortalitycongenital defects