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Scientific letter
Obstetric and perinatal complications in type 1 diabetes: A retrospective single-center study
Complicaciones obstétricas y perinatales en la diabetes tipo 1: estudio retrospectivo unicéntrico
Carmen González-Lamuñoa,
Corresponding author
carmenglamuno@gmail.com

Corresponding author.
, Gonzalo Díazb, Susana Garcíab, Vanesa Matíasa, Cristina Álvarezc, Mª. Pilar Bahílloa
a Servicio de Pediatría, Hospital Clínico Universitario Valladolid, Valladolid, Spain
b Servicio de Endocrinología, Hospital Clínico Universitario Valladolid, Valladolid, Spain
c Servicio de Obstetricia y Ginecología, Hospital Clínico Universitario Valladolid, Valladolid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Diabetes is the most common metabolic complication during pregnancy&#44; and poses an increased risk of negative effects in relation to the obstetric and perinatal outcomes&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The prevalence of coexisting pregestational diabetes&#44; mainly type 1 diabetes mellitus &#40;DM1&#41;&#44; during pregnancy is 1&#8211;2&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A retrospective study was made of all women diagnosed with pregestational DM1 and their newborn infants during a 7-year period &#40;2010&#8211;2017&#41;&#44; following the creation of our pregestational diabetes clinic&#46; Both the maternal and the newborn infant complications are described&#46; We excluded patients diagnosed with type 2 diabetes mellitus &#40;DM2&#41;&#44; gestational diabetes&#44; and those diagnosed with diabetes mellitus during pregnancy&#44; as well as other types of diabetes&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">A total of 39 pregnant women with pregestational DM1 and 33 newborn infants &#40;48&#46;7&#37; girls&#41; were evaluated&#44; since data on 6 infants could not be retrieved&#46; No miscarriages were recorded&#46; A total of 56&#46;4&#37; of the women had undergone preconception consultation&#44; and metabolic control was considered to be adequate for pregnancy&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the main characteristics of the study sample&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Of note was the high proportion of patients receiving subcutaneous insulin infusion&#44; as well as the proportion of patients with autoimmune thyroid disease &#40;25&#37; with Graves-Basedow&#8217;s disease&#44; 75&#37; with primary autoimmune hypothyroidism&#41;&#46; The mean HbA1c levels exhibited a progressive and significant decrease from before pregnancy to the time before delivery &#40;&#8722;1&#37; on average&#59; p&#8239;&#60;&#8239;0&#46;001&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">No serious obstetric complications related to diabetes were recorded&#44; though a percentage had diabetic nephropathy with positive microalbuminuria before pregnancy&#44; with no worsening during gestation&#46; There were no macrovascular complications&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">A high percentage of preterm deliveries were recorded&#44; with full-term deliveries in 69&#46;2&#37; of the cases&#46; Most deliveries were by caesarean section&#44; versus 20&#46;5&#37; eutocic deliveries and 18&#37; instrumented deliveries&#46; The number of induced deliveries could not be established&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The mean &#40;&#177; standard deviation &#91;SD&#93;&#41; birth weight was 3090&#46;49&#8239;&#177;&#8239;747&#46;29&#8239;g &#40;range 1260&#8211;4290&#41;&#44; with a high percentage of macrosomia &#40;weight percentile &#62;90&#41;&#46; A positive and significant linear correlation was observed &#40;r&#8239;&#61;&#8239;0&#46;35&#41;&#44; between HbA1c concentration and fetal weight during the third trimester &#40;p&#8239;&#60;&#8239;0&#46;05&#41;&#44; i&#46;e&#46;&#44; the higher the HbA1c value&#44; the greater the fetal weight&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In all&#44; 56&#46;41&#37; of the newborn infants required hospital admission &#40;43&#46;6&#37; in Neonatology&#44; 12&#46;8&#37; in the Neonatal Intensive Care Unit &#91;NICU&#93;&#41;&#44; with a mean stay of 10&#46;5&#8239;&#177;&#8239;9&#46;5 and 5&#8239;&#177;&#8239;5&#46;09 days&#44; respectively&#46; A total of 42&#46;4&#37; presented hypoglycemia&#44; and 85&#46;7&#37; required admission for treatment&#46; In addition&#44; 6&#46;1&#37; presented hypocalcemia&#44; while 15&#46;2&#37; exhibited polyglobulia&#44; and 60&#37; required intravenous fluid therapy&#46; Furthermore&#44; a total of 36&#46;4&#37; presented neonatal jaundice&#44; requiring phototherapy in 50&#37; of the cases&#46; One-third of the infants &#40;33&#46;3&#37;&#41; presented acute respiratory distress &#40;respiratory support proving necessary in 72&#46;7&#37;&#41;&#46; There was only one case of perinatal death due to panenterocolitis in the context of extreme prematurity&#46; Echocardiography was performed in 48&#46;6&#37; of the newborn infants&#44; with normal findings in only 6&#46;1&#37;&#46; The most common finding was septal hypertrophy &#40;12&#46;1&#37;&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The objective of strict metabolic control in pregnant women with diabetes is to avoid maternal complications and fetal problems&#46; In fact&#44; observational studies show that the risk of fetal malformations is mainly related to poor glycemic control in the first weeks of pregnancy &#40;i&#46;e&#46;&#44; the period of organogenesis&#41;&#59; the optimization of control should therefore be started before conception&#46; However&#44; it is well known that a considerable percentage of patients do not plan pregnancy&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> Kernaghan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> reported that women who plan pregnancy have a lower HbA1c concentration and therefore a lower obstetric complications rate than women who do not previously plan pregnancy&#46; Wahabi et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> in their meta-analysis&#44; found that pregestational care reduces HbA1c in the first trimester by an average of 1&#46;92&#37;&#44; and that effective pregestational control reduces congenital malformations and perinatal mortality&#46; In our series&#44; the high percentage of women treated with continuous subcutaneous insulin infusion &#40;CSII&#41; reflects attempts to secure the best possible metabolic control before and during pregnancy&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Johnstone et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> in coincidence with our own findings&#44; reported a positive correlation between HbA1c levels in the third trimester and birth weight&#46; They also found this correlation to be negative during the first trimester of pregnancy&#44; because higher HbA1c levels imply lesser placental development&#44; which results in increased intrauterine growth restriction &#40;IUGR&#41; and prematurity&#46; It should be noted that Yves et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> reported children of women with DM1 as having greater weight than the control group&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The delivery route depends on both the mother and on fetal monitoring&#46; No specific modality is recommended&#46; Although it has been reported that macrosomic fetuses are characterized by greater cephalic-pelvic disproportion&#44; this does not entail any specific recommendation for caesarean section&#46; Yves et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> reported a higher percentage of caesarean sections versus the global obstetric population studied&#46; This was also seen in our series&#44; where the percentage of caesarean sections in these women &#40;61&#46;5&#37;&#41; was much higher than the overall percentage of caesarean sections at the center &#40;24&#46;8&#37;&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Another complication of children of diabetic mothers is cardiac malformations&#46; In this regard&#44; it is important to perform a complete cardiological examination&#46; Septal hypertrophy is the predominant finding&#44; and is due to increased glycogen deposition in the myocardial cells&#46; Passarella et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> reported septal hypertrophy in 35&#46;4&#37; of cases&#46; This percentage is greater than in our study&#44; perhaps because echocardiography was not performed in all patients&#44; since echocardiography is not routinely performed in our center in infants born to diabetic mothers&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In conclusion&#44; despite the creation of specific gestational control units&#44; the maternal-fetal complications rate remains high&#46; New tools are needed to facilitate improved metabolic control in this subgroup of patients&#46;</p></span>"
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                  \t\t\t\t">14&#46;21 &#40;8&#46;09&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&#46;30 &#40;0&#46;65&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Gestational age at delivery &#40;weeks&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">36&#46;93 &#40;2&#46;08&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">20&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">10&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">7&#46;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">30&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">CSII&#47;MDI &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">42&#46;1&#47;57&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                            0 => "American College of Obstetricians and Gynecologists Committee on Practice Bulletin No&#46; 201"
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Article information
ISSN: 25300180
Original language: English
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2022 April 6 4 10
2022 March 4 9 13
2022 February 6 3 9
2022 January 13 4 17
2021 December 5 7 12
2021 November 7 4 11
2021 October 8 9 17
2021 September 7 4 11
2021 August 9 2 11
2021 July 6 5 11
2021 June 5 4 9
2021 May 8 7 15
2021 April 17 3 20
2021 March 1 0 1
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos