Stillbirth: what are the risk factors in women with diabetes?

  • Mackin ST & al.
  • Diabetologia
  • 29 Jul 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Maternal blood glucose levels and body mass index (BMI) are the main modifiable risk factors associated with stillbirth in women with diabetes.
  • Babies at extremes of weight centiles are at higher risk.

Why this matters

  • Stillbirth rates are highest at term among women with diabetes, and until more accurate prediction of at-risk pregnancies is available, earlier delivery may be considered an attractive option

Study design

  • A retrospective cohort study of singleton deliveries to mothers with type 1 diabetes (T1D; n=3778) and type 2 diabetes (T2D; n=1614).
  • Maternal and fetal characteristics, glycated haemoglobin (HbA1c) data and delivery timing were compared between stillborn and live-born groups.
  • Funding: The Chief Scientists Office of the Scottish Government.

Key results

  • Stillbirth rates were higher in women with T2D vs T1D (22.9 [95% CI, 16.4-31.8] vs 16.1 [95% CI, 12.4-20.8] per 1000 births).
  • In women with T1D, higher HbA1c before (OR, 1.03; 95% CI, 1.01-1.04; P=.0003) and later (OR, 1.06; 95% CI, 1.04-1.08; P<.0001 pregnancy were associated with a higher risk for stillbirth.>
  • Higher maternal BMI (OR, 1.07; 95% CI, 1.01-1.14; P=.02) and pre-pregnancy HbA1c (OR, 1.02; 95% CI, 1.00-1.04; P=.016) were associated with a higher risk for stillbirth in women with T2D.
  • Compared with infants with birthweights 10th-90th centile (20, stillbirths; 1685, live births), the risk for stillbirth was 6-fold higher in infants with birthweights
  • Risk for stillbirth was 2-fold higher in infants with birthweights >95th centile born to women with T2D (15, stillbirths; 402, live births).

Limitations

  • Retrospective design.