Quantitative assessment of the effect of pre-gestational diabetes and risk of adverse maternal, perinatal and neonatal outcomes

Lei Yu, Xiao-Ling Zeng, Ming-Liang Cheng, Guo-Zhen Yang, Bi Wang, Zi-Wen Xiao, Xin Luo, Bao-Fang Zhang, De-Wei Xiao, Shuai Zhang, Hua-Juan Liu, Ya-Xin Hu, Hou-Kang Lei, Qin-Fen Li, Zheng-Rong Wang, Lei Yu, Xiao-Ling Zeng, Ming-Liang Cheng, Guo-Zhen Yang, Bi Wang, Zi-Wen Xiao, Xin Luo, Bao-Fang Zhang, De-Wei Xiao, Shuai Zhang, Hua-Juan Liu, Ya-Xin Hu, Hou-Kang Lei, Qin-Fen Li, Zheng-Rong Wang

Abstract

Pregnancies complicated by pre-gestational diabetes (PGD) are associated with a higher rate of adverse outcomes, including an increased rage of preterm delivery, pregnancy-induced hypertension, pre-eclampsia, caesarean section, perinatal mortality, stillbirth, shoulder dystocia, macrosomia, small for gestational age, large for gestational age, low birth weight, neonatal hypoglycemia, neonatal death, low Apgar score, NICU admission, jaundice and respiratory distress. In the past two decades, numerous reports have been published regarding associations between PGD and risk of adverse outcomes. However, study results are inconsistent. To provide a synopsis of the current understanding of PGD for risk of adverse pregnancy outcomes, a random-effects meta-analysis over 40 million subjects from 100 studies was performed to calculate the pooled ORs. Potential sources of heterogeneity were systematically explored by multiple strata analyses and meta-regression. Overall, PGD were significantly associated with increased risk of preterm delivery (OR=3.48), LGA (OR=3.90), perinatal mortality (OR=3.39), stillbirth (OR=3.52), pre-eclampsia (OR=3.48), caesarean section (OR=3.52), NICU admission (OR=3.92), and neonatal hypoglycemia (OR=26.62). Significant results were also observed for 7 adverse outcomes with OR range from 1.54 to 2.82, while no association was found for SGA and respiratory distress after Bonferroni correction. We found that women with T1DM had higher risks for most of adverse pregnancy outcomes compared with women with T2DM. When stratified by study design, sample size, type of diabetes, geographic region, and study quality, significant associations remains. Our findings demonstrated that PGD is a strong risk-conferring factor for adverse maternal, perinatal and neonatal outcomes.

Keywords: adverse pregnancy outcomes; meta-analysis; pre-gestational diabetes; risk.

Conflict of interest statement

CONFLICTS OF INTEREST The authors confirm that this article content has no conflicts of interest.

Figures

Figure 1. Flow diagram for selection and…
Figure 1. Flow diagram for selection and inclusion of studies
Figure 2. Meta-analysis with a random-effect model…
Figure 2. Meta-analysis with a random-effect model for the association between pre-gestational diabetes and adverse pregnancy outcomes

References

    1. Lawrence JM, Contreras R, Chen W, Sacks DA. Trends in the prevalence of preexisting diabetes and gestational diabetes mellitus among a racially/ethnically diverse population of pregnant women, 1999-2005. Diabetes Care. 2008;31:899–904.
    1. Shand AW, Bell JC, McElduff A, Morris J, Roberts CL. Outcomes of pregnancies in women with pre-gestational diabetes mellitus and gestational diabetes mellitus; a population-based study in New South Wales, Australia, 1998-2002. Diabet Med. 2008;25:708–15.
    1. Kim SY, Dietz PM, England L, Morrow B, Callaghan WM. Trends in pre-pregnancy obesity in nine states, 1993-2003. Obesity (Silver Spring) 2007;15:986–93.
    1. Lapolla A, Dalfrà MG, Fedele D. Pregnancy complicated by type 2 diabetes: an emerging problem. Diabetes Res Clin Pract. 2008;80:2–7.
    1. Eidem I, Stene LC, Henriksen T, Hanssen KF, Vangen S, Vollset SE, Joner G. Congenital anomalies in newborns of women with type 1 diabetes: nationwide population-based study in Norway, 1999-2004. Acta Obstet Gynecol Scand. 2010;89:1403–11.
    1. Dabelea D, Mayer-Davis EJ, Saydah S, Imperatore G, Linder B, Divers J, Bell R, Badaru A, Talton JW, Crume T, Liese AD, Merchant AT, Lawrence JM, et al. SEARCH for Diabetes in Youth Study. Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009. JAMA. 2014;311:1778–86.
    1. Rosenbloom AL, Joe JR, Young RS, Winter WE. Emerging epidemic of type 2 diabetes in youth. Diabetes Care. 1999;22:345–54.
    1. Neufeld ND, Raffel LJ, Landon C, Chen YD, Vadheim CM. Early presentation of type 2 diabetes in Mexican-American youth. Diabetes Care. 1998;21:80–86.
    1. Feig DS, Palda VA. Type 2 diabetes in pregnancy: a growing concern. Lancet. 2002;359:1690–92.
    1. Platt MJ, Stanisstreet M, Casson IF, Howard CV, Walkinshaw S, Pennycook S, McKendrick O. St Vincent’s Declaration 10 years on: outcomes of diabetic pregnancies. Diabet Med. 2002;19:216–20.
    1. Chauhan SP, Laye MR, Lutgendorf M, McBurney JW, Keiser SD, Magann EF, Morrison JC. A multicenter assessment of 1,177 cases of shoulder dystocia: lessons learned. Am J Perinatol. 2014;31:401–06.
    1. Bartsch E, Medcalf KE, Park AL, Ray JG, and High Risk of Pre-eclampsia Identification Group Clinical risk factors for pre-eclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies. BMJ. 2016;353:i1753.
    1. Persson M, Norman M, Hanson U. Obstetric and perinatal outcomes in type 1 diabetic pregnancies: A large, population-based study. Diabetes Care. 2009;32:2005–09.
    1. Jensen DM, Damm P, Moelsted-Pedersen L, Ovesen P, Westergaard JG, Moeller M, Beck-Nielsen H. Outcomes in type 1 diabetic pregnancies: a nationwide, population-based study. Diabetes Care. 2004;27:2819–23.
    1. Evers IM, de Valk HW, Visser GH. Risk of complications of pregnancy in women with type 1 diabetes: nationwide prospective study in the Netherlands. BMJ. 2004;328:915.
    1. Yang J, Cummings EA, O’connell C, Jangaard K. Fetal and neonatal outcomes of diabetic pregnancies. Obstet Gynecol. 2006;108:644–50.
    1. Dekker GA, Lee SY, North RA, McCowan LM, Simpson NA, Roberts CT. Risk factors for preterm birth in an international prospective cohort of nulliparous women. PLoS One. 2012;7:e39154.
    1. Mirghani H, Begam M, Bekdache G, Khan F. Specialised fetal and maternal service: outcome of pre-gestational diabetes. J Obstet Gynaecol. 2012;32:426–29.
    1. Yu L, Cheng YJ, Cheng ML, Yao YM, Zhang Q, Zhao XK, Liu HJ, Hu YX, Mu M, Wang B, Yang GZ, Zhu LL, Zhang S. Quantitative assessment of common genetic variations in HLA-DP with hepatitis B virus infection, clearance and hepatocellular carcinoma development. Sci Rep. 2015;5:14933.
    1. Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, Hadden DR, McCance DR, Hod M, McIntyre HD, Oats JJ, Persson B, Rogers MS, Sacks DA, and HAPO Study Cooperative Research Group Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358:1991–2002.
    1. Parretti E, Mecacci F, Papini M, Cioni R, Carignani L, Mignosa M, La Torre P, Mello G. Third-trimester maternal glucose levels from diurnal profiles in nondiabetic pregnancies: correlation with sonographic parameters of fetal growth. Diabetes Care. 2001;24:1319–23.
    1. Sosenko IR, Kitzmiller JL, Loo SW, Blix P, Rubenstein AH, Gabbay KH. The infant of the diabetic mother: correlation of increased cord C-peptide levels with macrosomia and hypoglycemia. N Engl J Med. 1979;301:859–62.
    1. Evagelidou EN, Kiortsis DN, Bairaktari ET, Giapros VI, Cholevas VK, Tzallas CS, Andronikou SK. Lipid profile, glucose homeostasis, blood pressure, and obesity-anthropometric markers in macrosomic offspring of nondiabetic mothers. Diabetes Care. 2006;29:1197–201.
    1. Ornoy A. Growth and neurodevelopmental outcome of children born to mothers with pregestational and gestational diabetes. Pediatr Endocrinol Rev. 2005;3:104–13.
    1. Zhu Y, Olsen SF, Mendola P, Yeung EH, Vaag A, Bowers K, Liu A, Bao W, Li S, Madsen C, Grunnet LG, Granström C, Hansen S, et al. Growth and obesity through the first 7 y of life in association with levels of maternal glycemia during pregnancy: a prospective cohort study. Am J Clin Nutr. 2016;103:794–800.
    1. Persson B, Hanson U. Fetal size at birth in relation to quality of blood glucose control in pregnancies complicated by pregestational diabetes mellitus. Br J Obstet Gynaecol. 1996;103:427–33.
    1. Patel EM, Goodnight WH, James AH, Grotegut CA. Temporal trends in maternal medical conditions and stillbirth. Am J Obstet Gynecol. 2015;212(673):e1–11.
    1. Teramo K, Kari MA, Eronen M, Markkanen H, Hiilesmaa V. High amniotic fluid erythropoietin levels are associated with an increased frequency of fetal and neonatal morbidity in type 1 diabetic pregnancies. Diabetologia. 2004;47:1695–703.
    1. Lauenborg J, Mathiesen E, Ovesen P, Westergaard JG, Ekbom P, Mølsted-Pedersen L, Damm P. Audit on stillbirths in women with pregestational type 1 diabetes. Diabetes Care. 2003;26:1385–89.
    1. Rackham O, Paize F, Weindling AM. Cause of death in infants of women with pregestational diabetes mellitus and the relationship with glycemic control. Postgrad Med. 2009;121:26–32.
    1. Innes KE, Wimsatt JH, McDuffie R. Relative glucose tolerance and subsequent development of hypertension in pregnancy. Obstet Gynecol. 2001;97:905–10.
    1. Becker T, Vermeulen MJ, Wyatt PR, Meier C, Ray JG. Prepregnancy diabetes and risk of placental vascular disease. Diabetes Care. 2007;30:2496–98.
    1. Hanson U, Persson B. Epidemiology of pregnancy-induced hypertension and preeclampsia in type 1 (insulin-dependent) diabetic pregnancies in Sweden. Acta Obstet Gynecol Scand. 1998;77:620–24.
    1. Vangen S, Stoltenberg C, Holan S, Moe N, Magnus P, Harris JR, Stray-Pedersen B. Outcome of pregnancy among immigrant women with diabetes. Diabetes Care. 2003;26:327–32.
    1. Sibai BM, Caritis S, Hauth J, Lindheimer M, VanDorsten JP, MacPherson C, Klebanoff M, Landon M, Miodovnik M, Paul R, Meis P, Dombrowski M, Thurnau G, et al. and National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units Risks of preeclampsia and adverse neonatal outcomes among women with pregestational diabetes mellitus. Am J Obstet Gynecol. 2000;182:364–69.
    1. Balsells M, García-Patterson A, Gich I, Corcoy R. Maternal and fetal outcome in women with type 2 versus type 1 diabetes mellitus: a systematic review and metaanalysis. J Clin Endocrinol Metab. 2009;94:4284–91.
    1. Landon MB, Mele L, Spong CY, Carpenter MW, Ramin SM, Casey B, Wapner RJ, Varner MW, Rouse DJ, Thorp JM, Jr, Sciscione A, Catalano P, Harper M, et al. and Eunice Kennedy Shriver National Institute of Child Health, and Human Development (NICHD) Maternal–Fetal Medicine Units (MFMU) Network The relationship between maternal glycemia and perinatal outcome. Obstet Gynecol. 2011;117:218–24.
    1. Klingensmith GJ, Pyle L, Nadeau KJ, Barbour LA, Goland RS, Willi SM, Linder B, White NH, and TODAY Study Group Pregnancy Outcomes in Youth With Type 2 Diabetes: The TODAY Study Experience. Diabetes Care. 2016;39:122–29.
    1. Yu L, Zhang BF, Cheng ML, Zhao XK, Zhang Q, Hu YX, Liu HJ, Mu M, Wang B, Yang GZ, Zhu LL, Zhang S, Yao YM, et al. Quantitative assessment of mutations in hepatitis B virus genome with liver cirrhosis and hepatocellular carcinoma development. Oncotarget. 2016 May 17 [Epub ahead of print]
    1. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283:2008–12.
    1. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25:603–05.
    1. Aune D, Chan DS, Greenwood DC, Vieira AR, Rosenblatt DA, Vieira R, Norat T. Dietary fiber and breast cancer risk: a systematic review and meta-analysis of prospective studies. Ann Oncol. 2012;23:1394–402.
    1. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–88.
    1. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539–58.
    1. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–34.
    1. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50:1088–101.

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