Women with pregestational type 1 diabetes who experience stillbirths are more likely to have suboptimal glycemic control during pregnancy.
They are also more likely to have diabetic nephropathy, to
smoke and to have low educational and social attainment. That's according to an
audit of 25 stillbirths experienced by 22 type 1 diabetic women, the results of
which appear in the May issue of Diabetes Care. Three of the women had a history
of two stillbirths.
Dr. Jeannet Lauenborg from National University Hospital Rigshospitalet in
Copenhagen and a Danish team found a cause for seven stillbirths, namely
chorioamnionitis, ketoacidosis, placental abruption, and severe intrauterine
growth retardation.
They found a "likely" cause for stillbirth in six cases, namely severe
malformations, multiple placental infarctions, and thrombosis in the umbilical
cord.
There was no obvious explanation for the remaining 12 cases of stillbirth.
However, in 9 of these 12 (67%) cases, glycemic control was suboptimal (HbA1c >
7.5%). Glycemic control in both early and late pregnancy was poorer in the
stillbirth group when compared with a reference group consisting of 236 type 1
diabetic women without stillbirth.
Suboptimal glycemic control, the authors note, may "predispose
to fetal distress, due to fetal hyperinsulinemia, acidosis, and hyperlacticemia,
as maternal hyperglycemia and elevated HbA1c are risk factors for fetal
asphyxia, possibly leading to intrauterine death."
The team also found that the incidence of diabetic nephropathy was six times
higher in the stillbirth group than the reference group. Low educational level,
high unemployment, and smoking also characterized the stillbirth group.
These findings, Dr. Lauenborg and colleagues conclude, highlight a group of diabetic women deserving "more attention" during pregnancy, especially with regards to optimizing their glycemic control.
Source: Diabetes In Control Dot Com: Diabetes Care 2003;26:1385-1389.
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