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Blankstein AR, Sigurdson SM, Frehlich L, Raizman Z, Donovan LE, Lemieux P, Pylypjuk C, Benham JL, Yamamoto JM. Pre-existing Diabetes and Stillbirth or Perinatal Mortality: A Systematic Review and Meta-analysis. Obstet Gynecol 2024:00006250-990000000-01125. [PMID: 39088826 DOI: 10.1097/aog.0000000000005682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/23/2024] [Indexed: 08/03/2024]
Abstract
OBJECTIVE Despite the well-recognized association between pre-existing diabetes mellitus and stillbirth or perinatal mortality, there remain knowledge gaps about the strength of association across different populations. The primary objective of this systematic review and meta-analysis was to quantify the association between pre-existing diabetes and stillbirth or perinatal mortality, and secondarily, to identify risk factors predictive of stillbirth or perinatal mortality among those with pre-existing diabetes. DATA SOURCES MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials from inception to April 2022. METHODS OF STUDY SELECTION Cohort studies and randomized controlled trials in English or French that examined the association between pre-existing diabetes and stillbirth or perinatal mortality (as defined by the original authors) or identified risk factors for stillbirth and perinatal mortality in individuals with pre-existing diabetes were included. Data extraction was performed independently and in duplicate with the use of prespecified inclusion and exclusion criteria. Assessment for heterogeneity and risk of bias was performed. Meta-analyses were completed with a random-effects model. TABULATION, INTEGRATION, AND RESULTS From 7,777 citations, 91 studies met the inclusion criteria. Pre-existing diabetes was associated with higher odds of stillbirth (37 studies; pooled odds ratio [OR] 3.74, 95% CI, 3.17-4.41, I2=82.5%) and perinatal mortality (14 studies; pooled OR 3.22, 95% CI, 2.54-4.07, I2=82.7%). Individuals with type 1 diabetes had lower odds of stillbirth (pooled OR 0.81, 95% CI, 0.68-0.95, I2=0%) and perinatal mortality (pooled OR 0.73, 95% CI, 0.61-0.87, I2=0%) compared with those with type 2 diabetes. Prenatal care and prepregnancy diabetes care were significantly associated with lower odds of stillbirth (OR 0.26, 95% CI, 0.11-0.62, I2=87.0%) and perinatal mortality (OR 0.41, 95% CI, 0.29-0.59, I2=0%). CONCLUSION Pre-existing diabetes confers a more than threefold increased odds of both stillbirth and perinatal mortality. Maternal type 2 diabetes was associated with a higher risk of stillbirth and perinatal mortality compared with maternal type 1 diabetes. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42022303112.
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Affiliation(s)
- Anna R Blankstein
- Department of Medicine, the Department of Obstetrics, Gynecology and Reproductive Sciences, and the Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, the Department of Community Health Sciences, the Department of Medicine, the Department of Obstetrics and Gynecology, the Alberta Children's Hospital Research Institute, the O'Brien Institute for Public Health, and the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, and the Department of Medicine, Université Laval, Quebec City, Quebec, Canada; and Stanford Lifestyle Medicine, Stanford University, Redwood City, California
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Reitzle L, Heidemann C, Baumert J, Kaltheuner M, Adamczewski H, Icks A, Scheidt-Nave C. Pregnancy complications in women with pregestational and gestational diabetes mellitus. DEUTSCHES ÄRZTEBLATT INTERNATIONAL 2023; 120:81-86. [PMID: 36518030 PMCID: PMC10114134 DOI: 10.3238/arztebl.m2022.0387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 07/26/2022] [Accepted: 11/23/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Diabetes mellitus (DM) is a major risk factor for complications of pregnancy. Based on information for all inpatient births in Germany, we assessed the risks for selected pregnancy complications in women with pregestational diabetes mellitus (preDM) or gestational diabetes mellitus (GDM). METHODS The underlying data comprised all singleton births contained in the inpatient perinatal medicine quality assurance statistics for the years 2013-2019. The frequencies of premature birth, elevated birth weight (large for gestational age, LGA), cesarean section, transfer of the newborn to the perinatal unit, and stillbirth were stratified by maternal age and diabetes status (preDM, GDM, no DM). Poisson regression was used to calculate the relative risks (RR) with 95% confidence intervals (95% CI) for the whole period and for each individual year in women with preDM or GDM relative to women without DM. RESULTS Among the 4 991 275 singleton births included, GDM was documented in 283 210 (5.7%) and preDM in 46 605 (0.93%) cases. GDM was associated with higher RR for premature birth (1.13 [1.12; 1.15]), LGA (1.57 [1.55; 1.58]), cesarean section (1.26 [1.25; 1.27]), and transfer of the newborn (1.54 [1.52; 1.55]). These associations were even stronger in women with preDM: premature birth (2.13 [2.08; 2.18]), LGA (2.72 [2.67; 2.77]), cesarean section (1.62 [1.60; 1.64]), transfer of the newborn (2.61 [2.56; 2.66]). PreDM increased the risk of stillbirth (RR: 2.34 [2.11; 2.59]); GDM was associated with a lower risk (RR: 0.67 [0.62; 0.72]). For women with preDM, the risk of pregnancy complications increased over the study period. CONCLUSION GDM and preDM are still associated with elevated risks of pregnancy complications. In the case of preDM, the risks may be attributable to the fact that the hyperglycemia is more severe and is already present before conception. Continuous monitoring should include risk factors in pregnant women and care-relevant aspects.
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Durlach V, Vergès B, Al-Salameh A, Bahougne T, Benzerouk F, Berlin I, Clair C, Mansourati J, Rouland A, Thomas D, Thuillier P, Tramunt B, Le Faou AL. Smoking and diabetes interplay: A comprehensive review and joint statement. DIABETES & METABOLISM 2022; 48:101370. [PMID: 35779852 DOI: 10.1016/j.diabet.2022.101370] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Abstract
Evidence shows that smoking increases the risk of pre-diabetes and diabetes in the general population. Among persons with diabetes, smoking has been found to increase the risk of all-cause mortality and aggravate chronic diabetic complications and glycemic control. The current paper, which is a joint position statement by the French-Speaking Society on Tobacco (Société Francophone de Tabacologie) and the French-Speaking Society of Diabetes (Société Francophone du Diabète), summarizes the data available on the association between smoking and diabetes and on the impact of smoking and smoking cessation among individuals with type 1, type 2, and gestational diabetes mellitus. It also provides evidence-based information about the pharmacological and behavioral strategies for smoking cessation in these patients.
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Affiliation(s)
- Vincent Durlach
- Champagne-Ardenne University, UMR CNRS 7369 MEDyC & Cardio-Thoracic Department, Reims University Hospital, Reims, France.
| | - Bruno Vergès
- Department of Endocrinology, Diabetology and Metabolic Diseases, CHU Dijon, Dijon, France; INSERM LNC-UMR1231, University of Burgundy, Dijon, France
| | - Abdallah Al-Salameh
- Department of Endocrinology, Diabetes Mellitus and Nutrition, Amiens University Hospital, Amiens, France; PériTox = UMR-I 01, University of Picardy Jules Verne, Amiens, France
| | - Thibault Bahougne
- Department of Endocrinology and Diabetology, Strasbourg University Hospital, Strasbourg, France; Institute of Cellular and Integrative Neuroscience, CNRS UPR-3212, Strasbourg, France
| | - Farid Benzerouk
- Cognition Health and Society Laboratory (EA 6291), University of Reims Champagne-Ardenne, Reims, France; Department of Psychiatry, Reims University Hospital, Reims, France
| | - Ivan Berlin
- Department of Pharmacology, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - Carole Clair
- Department of Training, Research and Innovation, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Jacques Mansourati
- EA 4324 ORPHY, University of Western Brittany, Brest, France; Department of Cardiology, University Hospital of Brest, Brest, France
| | - Alexia Rouland
- Department of Endocrinology, Diabetology and Metabolic Diseases, CHU Dijon, Dijon, France
| | - Daniel Thomas
- Institute of Cardiology, Hôpital Pitié-Salpêtrière, Sorbonne University, Paris, France
| | - Philippe Thuillier
- Department of Endocrinology, Diabetology and Metabolic Diseases, University Hospital of Brest, Brest, France
| | - Blandine Tramunt
- Institute of Metabolic and Cardiovascular Diseases, UMR1297 INSERM/UPS, Toulouse University, Toulouse, Franc; Department of Diabetology, Metabolic Diseases and Nutrition, Toulouse University Hospital, Toulouse, France
| | - Anne-Laurence Le Faou
- Outpatient Addiction Center, Georges Pompidou European Hospital, AP-HP, Sorbonne Paris Cité, Paris, France
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Yamamoto JM, Pylypjuk C, Sellers E, McLeod L, Wicklow B, Sirski M, Prior H, Ruth C. Maternal and neonatal outcomes in pregnancies with type 2 diabetes in First Nation and other Manitoban people: a population-based study. CMAJ Open 2022; 10:E930-E936. [PMID: 36280248 PMCID: PMC9640167 DOI: 10.9778/cmajo.20220025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND First Nation people living in Canada experience a high prevalence of type 2 diabetes in pregnancy. In this study, we aimed to describe maternal and neonatal outcomes in First Nation and all other females with type 2 diabetes living in Manitoba, Canada. METHODS This was a population-level retrospective cohort study using linked administrative data from Manitoba (2012-2017). We compared First Nation females with type 2 diabetes with all other Manitoban females with type 2 diabetes, using relative risks (RRs) and 95% confidence intervals (CIs). RESULTS A total of 2181 females with type 2 diabetes were included, and 1218 (55.8%) were First Nation. First Nation females with type 2 diabetes were significantly more likely to experience stillbirth (RR 2.14, 95% CI 1.11-4.13) and perinatal death (RR 2.39, 95% CI 1.37-4.17) than all other Manitoban females with type 2 diabetes. Offspring of First Nation females with type 2 diabetes had a higher risk of most neonatal complications than offspring of all other Manitoban females with type 2 diabetes, including a higher risk of congenital malformations (RR 1.97, 95% CI 1.30-2.99), but First Nation people did not have a higher risk of most maternal complications. INTERPRETATION First Nation pregnant individuals living with type 2 diabetes experienced a higher risk for adverse pregnancy outcomes than all other Manitoban females with type 2 diabetes. Additional studies are needed to identify both high-risk and protective factors for pregnancy complications in First Nation people living with type 2 diabetes in pregnancy.
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Affiliation(s)
- Jennifer M Yamamoto
- Department of Internal Medicine (Yamamoto), University of Manitoba; Children's Hospital Research Institute of Manitoba (Yamamoto, Pylypjuk, Sellers, Wicklow); Departments of Obstetrics, Gynecology and Reproductive Sciences (Pylypjuk), and Pediatrics and Child Health (Sellers, Wicklow, Ruth), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (McLeod); Manitoba Centre for Health Policy (Sirski, Prior, Ruth), University of Manitoba, Winnipeg, Man
| | - Christy Pylypjuk
- Department of Internal Medicine (Yamamoto), University of Manitoba; Children's Hospital Research Institute of Manitoba (Yamamoto, Pylypjuk, Sellers, Wicklow); Departments of Obstetrics, Gynecology and Reproductive Sciences (Pylypjuk), and Pediatrics and Child Health (Sellers, Wicklow, Ruth), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (McLeod); Manitoba Centre for Health Policy (Sirski, Prior, Ruth), University of Manitoba, Winnipeg, Man
| | - Elizabeth Sellers
- Department of Internal Medicine (Yamamoto), University of Manitoba; Children's Hospital Research Institute of Manitoba (Yamamoto, Pylypjuk, Sellers, Wicklow); Departments of Obstetrics, Gynecology and Reproductive Sciences (Pylypjuk), and Pediatrics and Child Health (Sellers, Wicklow, Ruth), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (McLeod); Manitoba Centre for Health Policy (Sirski, Prior, Ruth), University of Manitoba, Winnipeg, Man
| | - Lorraine McLeod
- Department of Internal Medicine (Yamamoto), University of Manitoba; Children's Hospital Research Institute of Manitoba (Yamamoto, Pylypjuk, Sellers, Wicklow); Departments of Obstetrics, Gynecology and Reproductive Sciences (Pylypjuk), and Pediatrics and Child Health (Sellers, Wicklow, Ruth), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (McLeod); Manitoba Centre for Health Policy (Sirski, Prior, Ruth), University of Manitoba, Winnipeg, Man
| | - Brandy Wicklow
- Department of Internal Medicine (Yamamoto), University of Manitoba; Children's Hospital Research Institute of Manitoba (Yamamoto, Pylypjuk, Sellers, Wicklow); Departments of Obstetrics, Gynecology and Reproductive Sciences (Pylypjuk), and Pediatrics and Child Health (Sellers, Wicklow, Ruth), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (McLeod); Manitoba Centre for Health Policy (Sirski, Prior, Ruth), University of Manitoba, Winnipeg, Man
| | - Monica Sirski
- Department of Internal Medicine (Yamamoto), University of Manitoba; Children's Hospital Research Institute of Manitoba (Yamamoto, Pylypjuk, Sellers, Wicklow); Departments of Obstetrics, Gynecology and Reproductive Sciences (Pylypjuk), and Pediatrics and Child Health (Sellers, Wicklow, Ruth), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (McLeod); Manitoba Centre for Health Policy (Sirski, Prior, Ruth), University of Manitoba, Winnipeg, Man
| | - Heather Prior
- Department of Internal Medicine (Yamamoto), University of Manitoba; Children's Hospital Research Institute of Manitoba (Yamamoto, Pylypjuk, Sellers, Wicklow); Departments of Obstetrics, Gynecology and Reproductive Sciences (Pylypjuk), and Pediatrics and Child Health (Sellers, Wicklow, Ruth), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (McLeod); Manitoba Centre for Health Policy (Sirski, Prior, Ruth), University of Manitoba, Winnipeg, Man
| | - Chelsea Ruth
- Department of Internal Medicine (Yamamoto), University of Manitoba; Children's Hospital Research Institute of Manitoba (Yamamoto, Pylypjuk, Sellers, Wicklow); Departments of Obstetrics, Gynecology and Reproductive Sciences (Pylypjuk), and Pediatrics and Child Health (Sellers, Wicklow, Ruth), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (McLeod); Manitoba Centre for Health Policy (Sirski, Prior, Ruth), University of Manitoba, Winnipeg, Man.
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Cantarutti A, Rea F, Locatelli A, Merlino L, Lundin R, Perseghin G, Corrao G. Adherence to clinical evaluations in women with pre-existing diabetes during pregnancy: A call to action from an Italian real-life investigation. Diabetes Res Clin Pract 2019; 154:1-8. [PMID: 31220483 DOI: 10.1016/j.diabres.2019.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/04/2019] [Accepted: 06/12/2019] [Indexed: 12/24/2022]
Abstract
AIMS Women with pre-existing diabetes should plan for optimal care of the disease before, during and after pregnancy. The aim of this study was to assess the quality of diabetes mellitus monitoring and care before, during and after pregnancy in a large cohort of women. METHODS 1913 diabetic women resident in the Lombardy Region (Italy) who experienced at least a birth between 2011 and 2015 and exhibited signs of diabetes ≥2 years before delivery were identified using the healthcare utilization database. Antidiabetic care was defined via outpatient examinations (i.e., assessments of glycated haemoglobin, lipid profile, urine albumin excretion and serum creatinine, and dilated eye exams) and use of antidiabetic drugs. Differences in adherence to recommendations before, during and after pregnancy were assessed by the non-parametric McNemar's test among the whole cohort and among the subgroup with type 1 diabetes. RESULTS Adherence to recommendations was very poor before pregnancy, ranging from 13% to 42% for dilated eye and serum creatinine exam, respectively. During pregnancy, a significant portion of women increased adherence to all recommendations (e.g., glycated haemoglobin from 20% to 47%, p-value < 0.001), with the exception of lipid profile control. After pregnancy, adherence dropped to pre-pregnancy levels. A similar trend was observed in the use of antidiabetic drugs. Although women with type 1 diabetes showed better adherence across all periods, the same patterns emerged. CONCLUSIONS Besides an improvement in the indicators of clinical adherence during pregnancy, the management of diabetes among pregnant women remains sub-optimal both before and after the birth.
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Affiliation(s)
- Anna Cantarutti
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; Laboratory of Healthcare Research and Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Federico Rea
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; Laboratory of Healthcare Research and Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
| | - Anna Locatelli
- Obstetrics and Gynecology Unit, School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | - Luca Merlino
- Epidemiologic Observatory, Lombardy Regional Health Service, Milan, Italy
| | | | - Gianluca Perseghin
- Department of Internal Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; Laboratory of Healthcare Research and Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
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