Factors associated with stillbirth in women with diabetes

SDRN Epidemiology Group; Scottish Diabetic Group Pregnancy

doi:10.1007/s00125-019-4943-9

Factors associated with stillbirth in women with diabetes

SDRN Epidemiology Group, Scottish Diabetic Group Pregnancy

Research output: Contribution to journal › Article › peer-review

45 Citations (Scopus)

Abstract

Aims/hypothesis Stillbirth risk is increased in pregnancy complicated by diabetes. Fear of stillbirth has major influence on obstetric management, particularly timing of delivery. We analysed population-level data from Scotland to describe timing of stillbirths in women with diabetes and associated risk factors. Methods A retrospective cohort of singleton deliveries to mothers with type 1 (n = 3778) and type 2 diabetes (n = 1614) from 1 April 1998 to 30 June 2016 was analysed using linked routine care datasets. Maternal and fetal characteristics, HbA(1c) data and delivery timing were compared between stillborn and liveborn groups. Results Stillbirth rates were 16.1 (95% CI 12.4, 20.8) and 22.9 (95% CI 16.4, 31.8) per 1000 births in women with type 1 (n = 61) and type 2 diabetes (n = 37), respectively. In women with type 1 diabetes, higher HbA(1c) before pregnancy (OR 1.03 [95% CI 1.01, 1.04]; p = 0.0003) and in later pregnancy (OR 1.06 [95% CI 1.04, 1.08]; p <0.0001) were associated with stillbirth, while in women with type 2 diabetes, higher maternal BMI (OR 1.07 [95% CI 1.01, 1.14]; p = 0.02) and pre-pregnancy HbA(1c) (OR 1.02 [95% CI 1.00, 1.04]; p = 0.016) were associated with stillbirth. Risk was highest in infants with birthweights 95th centile born to women with type 2 diabetes (n = 15 stillbirths, 402 livebirths). A high proportion of stillborn infants were male among mothers with type 2 diabetes (81.1% vs 50.5% livebirths, p = 0.0002). A third of stillbirths occurred at term, with highest rates in the 38th week (7.0 [95% CI 3.7, 12.9] per 1000 ongoing pregnancies) among mothers with type 1 diabetes and in the 39th week (9.3 [95% CI 2.4, 29.2]) for type 2 diabetes. Conclusions/interpretation Maternal blood glucose levels and BMI are important modifiable risk factors for stillbirth in diabetes. Babies at extremes of weight centiles are at most risk. Many stillbirths occur at term and could potentially be prevented by change in routine care and delivery policies.

Original language	English
Pages (from-to)	1938-1947
Number of pages	10
Journal	Diabetologia
Volume	62
Issue number	10
Early online date	29 Jul 2019
DOIs	https://doi.org/10.1007/s00125-019-4943-9
Publication status	Published - Oct 2019

Bibliographical note

Acknowledgements We wish to thank the members of the Scottish
Diabetes Research Network Epidemiology Group who are involved in
data provisioning and data quality for this and other projects involving the
national diabetes dataset. The Scottish Diabetes Group Pregnancy subgroup is a multidisciplinary group involved in the care of women with
diabetes in pregnancy; we acknowledge their contribution to the data,
particularly in data provisioning and clinical care. We also acknowledge
the mothers with diabetes in Scotland. We also wish to thank the Glasgow
Children’s Hospital Charity who fund S.T. Mackin’s clinical research
fellowship.

Funding The SDRN Epidemiology Group receives financial support
from the Chief Scientists Office of the Scottish Government. Glasgow
Children’s Hospital Charity fund STM’s clinical research fellowship

Data Availability Statement

Due to the confidential nature of clinical records, our
data are not available in the public domain. SDRN Epidemiology Group
have developed a series of algorithms refining pseudonymised datasets
provisioned by ISD Scotland and can be contacted for collaboration.

Keywords

Birthweight
Epidemiology
Neonatal
Pregnancy
Stillbirth
Type 1 diabetes
Type 2 diabetes
PREGNANCY OUTCOMES
INFANT-DEATH
WEIGHT-GAIN
TYPE-1
RISK
FETAL
MORTALITY
MELLITUS

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Cite this

@article{45000a82314a47c9a46bd6b9cf4059e8,

title = "Factors associated with stillbirth in women with diabetes",

abstract = "Aims/hypothesis Stillbirth risk is increased in pregnancy complicated by diabetes. Fear of stillbirth has major influence on obstetric management, particularly timing of delivery. We analysed population-level data from Scotland to describe timing of stillbirths in women with diabetes and associated risk factors. Methods A retrospective cohort of singleton deliveries to mothers with type 1 (n = 3778) and type 2 diabetes (n = 1614) from 1 April 1998 to 30 June 2016 was analysed using linked routine care datasets. Maternal and fetal characteristics, HbA(1c) data and delivery timing were compared between stillborn and liveborn groups. Results Stillbirth rates were 16.1 (95% CI 12.4, 20.8) and 22.9 (95% CI 16.4, 31.8) per 1000 births in women with type 1 (n = 61) and type 2 diabetes (n = 37), respectively. In women with type 1 diabetes, higher HbA(1c) before pregnancy (OR 1.03 [95% CI 1.01, 1.04]; p = 0.0003) and in later pregnancy (OR 1.06 [95% CI 1.04, 1.08]; p <0.0001) were associated with stillbirth, while in women with type 2 diabetes, higher maternal BMI (OR 1.07 [95% CI 1.01, 1.14]; p = 0.02) and pre-pregnancy HbA(1c) (OR 1.02 [95% CI 1.00, 1.04]; p = 0.016) were associated with stillbirth. Risk was highest in infants with birthweights 95th centile born to women with type 2 diabetes (n = 15 stillbirths, 402 livebirths). A high proportion of stillborn infants were male among mothers with type 2 diabetes (81.1% vs 50.5% livebirths, p = 0.0002). A third of stillbirths occurred at term, with highest rates in the 38th week (7.0 [95% CI 3.7, 12.9] per 1000 ongoing pregnancies) among mothers with type 1 diabetes and in the 39th week (9.3 [95% CI 2.4, 29.2]) for type 2 diabetes. Conclusions/interpretation Maternal blood glucose levels and BMI are important modifiable risk factors for stillbirth in diabetes. Babies at extremes of weight centiles are at most risk. Many stillbirths occur at term and could potentially be prevented by change in routine care and delivery policies.",

keywords = "Birthweight, Epidemiology, Neonatal, Pregnancy, Stillbirth, Type 1 diabetes, Type 2 diabetes, PREGNANCY OUTCOMES, INFANT-DEATH, WEIGHT-GAIN, TYPE-1, RISK, FETAL, MORTALITY, MELLITUS",

author = "Mackin, {Sharon T.} and Nelson, {Scott M.} and Wild, {Sarah H.} and Colhoun, {Helen M.} and Rachael Wood and Lindsay, {Robert S.} and S. Gribble and A. Abubaker and A. Barnett and C. Fischbacher and E. Pearson and G. Leese and J. Chalmers and J. Mcknight and J. Petrie and N. Sattar and O. Wu and R. McCrimmon and S. Philip and S. Cunningham and {SDRN Epidemiology Group} and {Scottish Diabetic Group Pregnancy}",

note = "Acknowledgements We wish to thank the members of the Scottish Diabetes Research Network Epidemiology Group who are involved in data provisioning and data quality for this and other projects involving the national diabetes dataset. The Scottish Diabetes Group Pregnancy subgroup is a multidisciplinary group involved in the care of women with diabetes in pregnancy; we acknowledge their contribution to the data, particularly in data provisioning and clinical care. We also acknowledge the mothers with diabetes in Scotland. We also wish to thank the Glasgow Children{\textquoteright}s Hospital Charity who fund S.T. Mackin{\textquoteright}s clinical research fellowship. Funding The SDRN Epidemiology Group receives financial support from the Chief Scientists Office of the Scottish Government. Glasgow Children{\textquoteright}s Hospital Charity fund STM{\textquoteright}s clinical research fellowship",

year = "2019",

month = oct,

doi = "10.1007/s00125-019-4943-9",

language = "English",

volume = "62",

pages = "1938--1947",

journal = "Diabetologia",

issn = "0012-186X",

publisher = "Springer ",

number = "10",

}

TY - JOUR

T1 - Factors associated with stillbirth in women with diabetes

AU - Mackin, Sharon T.

AU - Nelson, Scott M.

AU - Wild, Sarah H.

AU - Colhoun, Helen M.

AU - Wood, Rachael

AU - Lindsay, Robert S.

AU - Gribble, S.

AU - Abubaker, A.

AU - Barnett, A.

AU - Fischbacher, C.

AU - Pearson, E.

AU - Leese, G.

AU - Chalmers, J.

AU - Mcknight, J.

AU - Petrie, J.

AU - Sattar, N.

AU - Wu, O.

AU - McCrimmon, R.

AU - Philip, S.

AU - Cunningham, S.

AU - SDRN Epidemiology Group

AU - Scottish Diabetic Group Pregnancy

N1 - Acknowledgements We wish to thank the members of the Scottish Diabetes Research Network Epidemiology Group who are involved in data provisioning and data quality for this and other projects involving the national diabetes dataset. The Scottish Diabetes Group Pregnancy subgroup is a multidisciplinary group involved in the care of women with diabetes in pregnancy; we acknowledge their contribution to the data, particularly in data provisioning and clinical care. We also acknowledge the mothers with diabetes in Scotland. We also wish to thank the Glasgow Children’s Hospital Charity who fund S.T. Mackin’s clinical research fellowship. Funding The SDRN Epidemiology Group receives financial support from the Chief Scientists Office of the Scottish Government. Glasgow Children’s Hospital Charity fund STM’s clinical research fellowship

PY - 2019/10

Y1 - 2019/10

N2 - Aims/hypothesis Stillbirth risk is increased in pregnancy complicated by diabetes. Fear of stillbirth has major influence on obstetric management, particularly timing of delivery. We analysed population-level data from Scotland to describe timing of stillbirths in women with diabetes and associated risk factors. Methods A retrospective cohort of singleton deliveries to mothers with type 1 (n = 3778) and type 2 diabetes (n = 1614) from 1 April 1998 to 30 June 2016 was analysed using linked routine care datasets. Maternal and fetal characteristics, HbA(1c) data and delivery timing were compared between stillborn and liveborn groups. Results Stillbirth rates were 16.1 (95% CI 12.4, 20.8) and 22.9 (95% CI 16.4, 31.8) per 1000 births in women with type 1 (n = 61) and type 2 diabetes (n = 37), respectively. In women with type 1 diabetes, higher HbA(1c) before pregnancy (OR 1.03 [95% CI 1.01, 1.04]; p = 0.0003) and in later pregnancy (OR 1.06 [95% CI 1.04, 1.08]; p <0.0001) were associated with stillbirth, while in women with type 2 diabetes, higher maternal BMI (OR 1.07 [95% CI 1.01, 1.14]; p = 0.02) and pre-pregnancy HbA(1c) (OR 1.02 [95% CI 1.00, 1.04]; p = 0.016) were associated with stillbirth. Risk was highest in infants with birthweights 95th centile born to women with type 2 diabetes (n = 15 stillbirths, 402 livebirths). A high proportion of stillborn infants were male among mothers with type 2 diabetes (81.1% vs 50.5% livebirths, p = 0.0002). A third of stillbirths occurred at term, with highest rates in the 38th week (7.0 [95% CI 3.7, 12.9] per 1000 ongoing pregnancies) among mothers with type 1 diabetes and in the 39th week (9.3 [95% CI 2.4, 29.2]) for type 2 diabetes. Conclusions/interpretation Maternal blood glucose levels and BMI are important modifiable risk factors for stillbirth in diabetes. Babies at extremes of weight centiles are at most risk. Many stillbirths occur at term and could potentially be prevented by change in routine care and delivery policies.

AB - Aims/hypothesis Stillbirth risk is increased in pregnancy complicated by diabetes. Fear of stillbirth has major influence on obstetric management, particularly timing of delivery. We analysed population-level data from Scotland to describe timing of stillbirths in women with diabetes and associated risk factors. Methods A retrospective cohort of singleton deliveries to mothers with type 1 (n = 3778) and type 2 diabetes (n = 1614) from 1 April 1998 to 30 June 2016 was analysed using linked routine care datasets. Maternal and fetal characteristics, HbA(1c) data and delivery timing were compared between stillborn and liveborn groups. Results Stillbirth rates were 16.1 (95% CI 12.4, 20.8) and 22.9 (95% CI 16.4, 31.8) per 1000 births in women with type 1 (n = 61) and type 2 diabetes (n = 37), respectively. In women with type 1 diabetes, higher HbA(1c) before pregnancy (OR 1.03 [95% CI 1.01, 1.04]; p = 0.0003) and in later pregnancy (OR 1.06 [95% CI 1.04, 1.08]; p <0.0001) were associated with stillbirth, while in women with type 2 diabetes, higher maternal BMI (OR 1.07 [95% CI 1.01, 1.14]; p = 0.02) and pre-pregnancy HbA(1c) (OR 1.02 [95% CI 1.00, 1.04]; p = 0.016) were associated with stillbirth. Risk was highest in infants with birthweights 95th centile born to women with type 2 diabetes (n = 15 stillbirths, 402 livebirths). A high proportion of stillborn infants were male among mothers with type 2 diabetes (81.1% vs 50.5% livebirths, p = 0.0002). A third of stillbirths occurred at term, with highest rates in the 38th week (7.0 [95% CI 3.7, 12.9] per 1000 ongoing pregnancies) among mothers with type 1 diabetes and in the 39th week (9.3 [95% CI 2.4, 29.2]) for type 2 diabetes. Conclusions/interpretation Maternal blood glucose levels and BMI are important modifiable risk factors for stillbirth in diabetes. Babies at extremes of weight centiles are at most risk. Many stillbirths occur at term and could potentially be prevented by change in routine care and delivery policies.

KW - Birthweight

KW - Epidemiology

KW - Neonatal

KW - Pregnancy

KW - Stillbirth

KW - Type 1 diabetes

KW - Type 2 diabetes

KW - PREGNANCY OUTCOMES

KW - INFANT-DEATH

KW - WEIGHT-GAIN

KW - TYPE-1

KW - RISK

KW - FETAL

KW - MORTALITY

KW - MELLITUS

U2 - 10.1007/s00125-019-4943-9

DO - 10.1007/s00125-019-4943-9

M3 - Article

SN - 0012-186X

VL - 62

SP - 1938

EP - 1947

JO - Diabetologia

JF - Diabetologia

IS - 10

ER -

Factors associated with stillbirth in women with diabetes

Abstract

Bibliographical note

Data Availability Statement

Keywords

UN SDGs

Access to Document

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Cite this