Pregnancy for women with diabetes remains high risk and more work is needed to ensure mothers and babies in Scotland get the best care, say researchers behind a new study.
The research found both type 1 and type 2 diabetes were linked to complications in pregnancy, including stillbirths and emergency Caesarean sections, and identified a “major unmet need” when it came to improving outcomes.
“The prevalence of both type 1 and particularly type 2 diabetes complicating pregnancy is increasing”
It is based on analysis of nearly 814,000 births in Scotland over 15 years, which reveals “marked differences” in pregnancy outcomes for women with diabetes compared to non-diabetic women.
For example, the rate of stillbirths was found to be four times higher for women with type 1 diabetes and five times higher for those with type 2.
Women with diabetes were more likely to give birth pre-term – at less than 37 weeks – according to the research in Diabetologica – the journal of the European Association for the Study of Diabetes.
Meanwhile more than half – 51% – of all babies born to mothers with type 1 diabetes were large for their gestational age, which brings increased risk of complications. That was the case for 38% of babies born to mothers with type 2 diabetes.
Of particular concern was the fact that the proportion of large babies born to mothers with type 1 was shown to be increasing, said the researchers from the University of Glasgow who led the work.
Carried out in collaboration with other Scottish institutions and hospitals, the study found interventions, like elective or emergency C-sections, occurred much more frequently in those with diabetes.
“There is a major unmet need to improve perinatal outcomes for women with diabetes treated during pregnancy”
In all, 68% of women with type 1 diabetes and 60% of women with type 2 had babies delivered in theatre – compared to overall rates of around a quarter.
While surgical intervention had become more common overall, the researchers found a “striking” rise in emergency C-sections among women with type 2 diabetes at the same time as rates in England and Wales have been dropping.
“Although diabetes in pregnancy remains relatively uncommon – one in 178 births in our data – the prevalence of both type 1 and particularly type 2 diabetes complicating pregnancy is increasing,” said the study authors.
Factors behind this could include higher rates of obesity, increased numbers of older mothers and “modest increases” in certain at-risk ethnic populations, said the researchers, who highlighted the impact on specialist services.
“Although still representing just a small fraction of the overall obstetric population, these increases have important resource implications for service delivery in specialist clinics,” they said.
The researchers highlighted that more work was needed to understand the most effective interventions and improve care.
“There is a major unmet need to improve perinatal outcomes for women with diabetes treated during pregnancy,” they said. “Novel approaches and technologies will be needed to address this.”