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Reischer T, Prossinger S, Catic A, Healy E, Göbl C, Yerlikaya-Schatten G. Factors Affecting Mode of Birth in Women With Preexisting Diabetes and Gestational Diabetes: A Retrospective Cohort at a Tertiary Referral Center. J Diabetes Res 2024; 2024:5561761. [PMID: 38883259 PMCID: PMC11178421 DOI: 10.1155/2024/5561761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/25/2024] [Accepted: 05/11/2024] [Indexed: 06/18/2024] Open
Abstract
Women with preexisting diabetes and gestational diabetes mellitus (GDM) are at higher risk for adverse maternal and neonatal outcomes. However, there is no consensus on a uniform approach regarding mode of birth (MOB) for all forms of diabetes. The aim of the study is to compare MOB in women with preexisting diabetes and GDM and possible factors influencing it. A retrospective cohort study of women with GDM and preexisting diabetes between 2015 and 2021 at a tertiary referral center was conducted. One thousand three hundred eighty-five singleton pregnancies were included. One thousand twenty-two (74.4%) women had a vaginal birth (VB) and 351 (25.6%) a caesarean section. Preexisting diabetes was significantly associated with caesarean section compared to GDM (OR 2.43). Five hundred fifty-one (40.1%) women underwent induction of labor, and 122 (22.1%) women had a secondary caesarean after IOL. Women induced due to spontaneous rupture of membrane (SROM) achieved the highest rate of VB at 93%. The lowest rates of VB occurred if indication for induction was for preeclampsia or hypertension. IOL was significantly less successful in preexisting diabetes with a VB achieved in 56.4% for type 1 diabetes and 52.6% of type 2 diabetes compared to GDM (78.2% in GDM; 81.2% in IGDM; OR 3.25, 95% CI 1.70-6.19, p < 0.001). The rate of VB was higher who were induced preterm compared to women with term IOL (n = 240 (81.9%) vs. n = 199 (73.2%); p < 0.05). Parity, previous VB and SROM favored VB after IOL, whereas preexisting diabetes, hypertension, and IOL after 40 + 0 weeks are independent risk factors for caesarean delivery.
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Affiliation(s)
- Theresa Reischer
- Department of Gynaecology and Obstetrics Division of Feto-Maternal Medicine Medical University of Vienna, Vienna, Austria
| | - Sina Prossinger
- Department of Gynaecology and Obstetrics Division of Feto-Maternal Medicine Medical University of Vienna, Vienna, Austria
| | - Anja Catic
- Department of Gynaecology and Obstetrics Division of Feto-Maternal Medicine Medical University of Vienna, Vienna, Austria
| | - Eibhlin Healy
- Fetal Medicine Unit Liverpool Women's Hospital, Liverpool, UK
| | - Christian Göbl
- Department of Gynaecology and Obstetrics Division of Feto-Maternal Medicine Medical University of Vienna, Vienna, Austria
| | - Gülen Yerlikaya-Schatten
- Department of Gynaecology and Obstetrics Division of Feto-Maternal Medicine Medical University of Vienna, Vienna, Austria
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Chimenea A, Calderón AM, Antiñolo G, Moreno-Reina E, García-Díaz L. Assessing the impact of pregnancy planning on obstetric and perinatal outcomes in women with pregestational diabetes mellitus. Diabetes Res Clin Pract 2024; 209:111599. [PMID: 38423476 DOI: 10.1016/j.diabres.2024.111599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/17/2024] [Accepted: 02/25/2024] [Indexed: 03/02/2024]
Abstract
AIMS We investigated the role of pregnancy planning in improving glycemic control and its potential impact on the overall pregnancy outcomes, obstetric outcomes, and perinatal well-being in women with pregestational diabetes mellitus (PGDM). METHODS A retrospective observational cohort study was conducted, including all pregnant women with PGDM treated in our center 2012 and 2018. RESULTS Among 425 participants, 26.6 % had planned pregnancies. The lowest rate of pregnancy planning was observed in women with type 2 diabetes mellitus (6.5 %). Women with planned pregnancies had lower BMI. Both pregestational HbA1c levels (6.66 % vs. 7.61 %, p < 0.001) and HbA1c levels at the first prenatal visit (6.39 % vs. 7.24 %, p < 0.001) were significantly lower in the planned pregnancy group. These differences persisted until the end of pregnancy (6.09 % vs. 6.47 %, p = 0.006). Although better glycemic control was associated with a non-significant decrease in fetuses with birth weight over 4000 g (18.1 % vs. 22.1 %) and 4500 g (3.0 % vs. 4.2 %), we did not find significant effects on other morbidity events, maternal outcomes, or the cesarean section rate. CONCLUSIONS Pregnancy planning in PGDM women improved glycemic control and HbA1c levels. Limited impact on obstetric and perinatal outcomes suggests scope for other focused interventions to optimize maternal and fetal health.
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Affiliation(s)
- Angel Chimenea
- Department of Materno-Fetal Medicine, Genetics and Reproduction, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain; Fetal, IVF and Reproduction Simulation Training Centre (FIRST), Seville, Spain
| | - Ana María Calderón
- Department of Gynecology, Hospital Universitario Virgen del Rocio, Seville, Spain.
| | - Guillermo Antiñolo
- Department of Materno-Fetal Medicine, Genetics and Reproduction, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain; Fetal, IVF and Reproduction Simulation Training Centre (FIRST), Seville, Spain; Department of Surgery, University of Seville, Seville, Spain; Centre for Biomedical Network Research on Rare Diseases (CIBERER), Seville, Spain
| | - Eduardo Moreno-Reina
- Department of Materno-Fetal Medicine, Genetics and Reproduction, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain
| | - Lutgardo García-Díaz
- Department of Materno-Fetal Medicine, Genetics and Reproduction, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain; Department of Surgery, University of Seville, Seville, Spain
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Anabusi S, Izenberg A, Barnett C, Berndl A. Pregnancy planning may impact maternal and neonatal outcomes in people with myasthenia gravis. Muscle Nerve 2024; 69:318-324. [PMID: 38156425 DOI: 10.1002/mus.28021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 12/04/2023] [Accepted: 12/10/2023] [Indexed: 12/30/2023]
Abstract
INTRODUCTION Myasthenia Gravis (MG) is an acquired autoimmune condition commonly diagnosed in young people of reproductive age resulting in neuromuscular junction dysfunction. The course of MG during pregnancy and its impact on maternal and neonatal outcomes is vary in the literature. Pregnancy planning is a known strategy and modifiable risk factor in obstetric practice to decrease maternal and neonatal morbidity. We aim to assess if planning a pregnancy impacts maternal and neonatal outcomes, MG exacerbation, and pregnancy-related complications. METHODS This study utilized data from an online, North American survey entitled "A Patient Centered study on Pregnancy in People with Myasthenia Gravis", distributed with the assistance of MG advocacy groups in the United States and Canada. It included individuals with MG who had at least one pregnancy in the last 10-years. Key maternal and neonatal outcomes were compared between planned and unplanned pregnancies. RESULTS Out of 156 survey participants, 58 had a pregnancy following MG diagnosis, totaling 90 reported pregnancies. Of these, 56 (62.2%) were planned and 34 (37.8%) were unplanned pregnancies. The unplanned pregnancies were associated with more MG exacerbations, hospitalizations, and intensive care unit admission (37.7% vs. 13.7%, 26.5% vs. 11%, and 17.6% vs. 8.9%, respectively, p ≤ .05). The neonatal outcomes did not significantly differ between the groups. DISCUSSION Planned pregnancies in people with MG may be associated with a reduced gestational and post-partum risk of MG exacerbation, hospitalizations, and ICU admissions. Larger studies are required to confirm this association and account for potential contributing variables.
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Affiliation(s)
- Saja Anabusi
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Accessible Care Pregnancy Clinic, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Obstetrics and Gynecology, University of Toronto, Ontario, Canada
| | - Aaron Izenberg
- Department of Neurology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Carolina Barnett
- Division of Neurology, Department of Medicine, University Health Network and University of Toronto, Ontario, Canada
| | - Anne Berndl
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Accessible Care Pregnancy Clinic, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Obstetrics and Gynecology, University of Toronto, Ontario, Canada
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Fisher SA, Huang J, DuBord AY, Xu NY, Beestrum M, Niznik C, Yeung AM, Nguyen KT, Klonoff DC, Yee LM. Continuous Subcutaneous Infusion Versus Multiple Daily Injections of Insulin for Pregestational Diabetes in Pregnancy: A Systematic Review and Meta-Analysis. J Diabetes Sci Technol 2023; 17:1337-1363. [PMID: 37542367 PMCID: PMC10563519 DOI: 10.1177/19322968231186626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
BACKGROUND The use of continuous subcutaneous insulin infusion (CSII) therapy in pregnancies affected by pregestational diabetes mellitus (DM) has generated mixed outcome data worthy of further investigation. This systematic review and meta-analysis aims to evaluate clinical outcomes associated with CSII versus multiple daily injections (MDIs) in pregnant persons with pregestational DM. METHODS A predefined, systematic, librarian-assisted search of MEDLINE (PubMed), Embase, Cochrane Library, Scopus, ClinicalTrials.gov, and World Health Organization International Clinical Trial Registry Platform (published from 2010 to 2022) yielded 3003 studies describing pregnancy outcomes associated with CSII and/or MDI for pregestational DM. The primary exposure was mode of insulin administration, with cesarean delivery and neonatal hypoglycemia as the primary maternal and neonatal outcomes, respectively. Secondary outcomes included hypertensive disorders of pregnancy, first and third-trimester glycemic control, large-for-gestational age (LGA) neonate, preterm birth, neonatal intensive care unit admission, need for respiratory support, hyperbilirubinemia, 5-minute Apgar <7, shoulder dystocia, and perinatal mortality. We calculated pooled odds ratios (OR) with 95% confidence intervals (CI) using random-effects models. RESULTS Among 39 eligible studies, 39% of the 5518 pregnancies included were exposed to CSII. Odds of cesarean delivery were higher with CSII (20 studies: 63% vs 56%, odds ratio [OR] 1.3 [95% confidence interval (CI) 1.2-1.5]), but we did not identify a difference in the odds of neonatal hypoglycemia (23 studies: 31% vs 34%, OR 1.1 [95% CI 0.9-1.5]). Among secondary outcomes, only the odds of LGA (20 studies: 47% vs 38%, OR 1.4 [95% CI 1.2-1.6]) were higher in individuals using CSII versus MDI. CONCLUSIONS Use of CSII (vs MDI) for pregestational DM in pregnancy is associated with higher odds of cesarean delivery and delivery of an LGA neonate. Further evaluation of how CSII use may influence neonatal size and delivery route is warranted.
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Affiliation(s)
- Stephanie A. Fisher
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Nicole Y. Xu
- San Diego School of Medicine, University of California, La Jolla, CA, USA
| | - Molly Beestrum
- Galter Health Sciences Library & Learning Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Charlotte Niznik
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - David C. Klonoff
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
| | - Lynn M. Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Weschenfelder F, Herrmann E, Lehmann T, Schleußner E, Kloos C, Battfeld W, Groten T. Predictors of a successful vaginal delivery in women with type 1 diabetes: a retrospective analysis of 20 years. Arch Gynecol Obstet 2022; 305:1445-1452. [PMID: 34559296 PMCID: PMC9166876 DOI: 10.1007/s00404-021-06255-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/13/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE To evaluate the independent factors associated with the success of a trial of vaginal birth (TVB) in women with type 1 diabetes. Despite all therapeutic efforts and technological innovations, rates of caesarean sections (CS) in pregnant women with type 1 diabetes remain unchanged above 60%. Our aim was to point out influencing factors to improve the quality of antepartum counseling. METHODS We performed a retrospective cohort study of 195 pregnancies with type 1 diabetes treated between 2000 and 2019. After exclusions, 118 women with near-term singleton pregnancies intended vaginal birth (TVB). Group differences between CS and successful vaginal delivery were analyzed. Multivariate logistic regression was performed by including clinical and metabolic variables to determine the independent effects on a successful vaginal delivery. Subgroup analysis for nulliparous women. RESULTS Of 118 women with TVB, 67 (56.8%) were delivered vaginally. History of previous vaginal delivery (OR 10.29; CI 2.39; 44.30), HbA1c changes during pregnancy (per % increase; OR 0.59; CI 0.36; 0.96) and gestational weight gain (per kg; OR 0.87; CI 0.80; 0.96) were independent predictors for a successful vaginal delivery. In nulliparous women, the duration of diabetes was independently and negatively associated with vaginal delivery. CONCLUSION Provided data can help to improve antepartum counseling in type 1 diabetic patients. It seems that women with type 1 diabetes should avoid postponing pregnancy and childbirth.
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Affiliation(s)
| | - Eva Herrmann
- Department of Obstetrics, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Thomas Lehmann
- University Hospital Jena, Institute of Medical Statistics and Computer Science, Friedrich Schiller University, Jena, Germany
| | - Ekkehard Schleußner
- Department of Obstetrics, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Christof Kloos
- Department Internal Medicine III; FB Endocrinology and Metabolic Diseases, University Hospital Jena, Jena, Germany
| | | | - Tanja Groten
- Department of Obstetrics, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
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Geplante Schwangerschaften mit signifikanten Vorteilen. DIABETOL STOFFWECHS 2021. [DOI: 10.1055/a-1317-5102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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