Factors associated with stillbirth in women with diabetes

SDRN Epidemiology Group, Scottish Diabetic Group Pregnancy

Research output: Contribution to journalArticlepeer-review

44 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 languageEnglish
Pages (from-to)1938-1947
Number of pages10
JournalDiabetologia
Volume62
Issue number10
Early online date29 Jul 2019
DOIs
Publication statusPublished - 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.
Data availability 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.
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

Keywords

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

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