Pre-Existing Diabetes Linked to Over Threefold Increase in Stillbirth and Perinatal Mortality Risk: Study
A systematic review and meta-analysis by researchers found that pre-existing diabetes tripled the risk of stillbirth and perinatal mortality. This study was published in the Obstetrics and Gynecology journal by Blankstein A. and colleagues. Data from 91 studies of people with pre-existing diabetes were combined, and the summary estimate revealed that people with type 2 diabetes have a significantly higher risk of adverse pregnancy outcome compared to those with type 1 diabetes.
Diabetes mellitus, in particular that pre-existing before pregnancy, has been considered an established risk factor for adverse pregnancy outcomes including stillbirth and perinatal mortality. However, the strength of association across populations and relative risk across type 1 versus type 2 diabetes has been less clear. This current study will quantify the association of pre-existing diabetes with the risk of stillbirth and perinatal mortality, and identify predictive risk factors that could inform clinical practice and patient care.
The review and meta-analysis were conducted in accordance with data from MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials from inception up to April 2022. Cohort and randomized controlled trial studies were identified in this review as studies targeting an association between pre-existing diabetes and stillbirth or perinatal mortality. To address the heterogeneity among studies, a random-effects model was applied. A total of 7777 citations were identified through the title and abstract screening, and 91 full-text articles were on the list of potentially eligible articles.
Key Findings
Association with Stillbirth
• The pooled OR for stillbirth was 3.74 (95% CI, 3.17–4.41) when used with pre-existing diabetes. This pooled estimate was based on data from 37 studies, with noted heterogeneity of I2 = 82.5%.
Association with Perinatal Mortality:
• The overall risk of perinatal mortality associated with pre-existing diabetes was increased, with a pooled OR of 3.22 (95% CI, 2.54–4.07) from 14 studies, with similar heterogeneity of I2=82.7%.
Type 1 versus Type 2 Diabetes:
• Women with type 1 diabetes have a lower risk of stillbirth (pooled OR 0.81, 95% CI, 0.68–0.95) and perinatal mortality (pooled OR 0.73, 95% CI, 0.61–0.87), compared to women with type 2 diabetes, with no statistical heterogeneity present in these comparisons (I2=0%).
Impact of Prenatal and Prepregnancy Care:
• The study emphasized the protective effect of prenatal care and prepregnancy diabetes management. These interventions, indeed, had significantly lower odds for stillbirth, with an OR of 0.26 (95% CI, 0.11–0.62, I2=87.0%), and for perinatal mortality, with an OR of 0.41 (95% CI, 0.29–0.59, I2=0%).
This systematic review and meta-analysis affirm that pre-existing diabetes carries an increased risk of stillbirth and perinatal mortality and that the risk with maternal type 2 diabetes is higher than that with type 1 diabetes. Prenatal and preconception care play crucial roles in mitigation, while at the same time offering pathways to achieving better outcomes for both the mother and child.
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