- Email: [email protected]
Pregnancy outcomes in patients with type 1 diabetes in China: a retrospective study
Abstracts
Pregnancy outcomes in patients with type 1 diabetes in China: a retrospective study Xueying Zheng, Jinhua Yan, Daizhi Yang, Sihui Luo, Dalong Zhu, Xingwu Ran, Jiajun Zhao, Xinhua Xiao, Xiaohui Guo, Tao Yang, Qin Huang , Zhiguang Zhou, Fang Liu, Ji Hu, Jing Lu, Jing Ma, Xinli Zhou, Fan Ping, Nan Gu, Mei Zhang, Wenwen Li, Yaling Yang, Chen Fang, Huixia Yang, Jianping Weng
Abstract Background Sparse data on pregnancy outcomes for women with type 1 diabetes exist in Chinese women. We aimed to investigate maternal, perinatal, and fetal and neonatal outcomes in women with type 1 diabetes in China. Method We did a retrospective study in 11 hospitals in Beijing, Jinan, Nanjing, Shanghai, Chengdu, Changsha, Guangzhou. We compiled data on pregnancy outcomes of women with type 1 diabetes from anonymised medical records of maternal and infant birth between Jan 1, 2004, to Dec 31, 2014. We analysed perinatal maternal mortality, perinatal neonatal mortality, and perinatal birth defect rate. These outcomes in the general population were estimated from the annual report of national health statistic and the report of birth defects in China. We used χ² or Fisher’s exact test for statistical analyses of categorical data. Ethics approval was granted by all the participating hospitals. Findings We included 289 women with type 1 diabetes with a singleton pregnancy, of whom 26 (9%) had a history of adverse pregnancy outcomes at the start of the study period. At start of pregnancy, mean age was 27·6 years (SD 4·2) and mean diabetes duration was 5·26 years (SD 5·49). Nine women were excluded because of elective terminations and 15 were excluded because no data on pregnancy outcomes were available; thus, 265 women were included in the analysis. In patients with HbA1c records available, 41 (57%) of 72 achieved the preconception HbA1c target (≤7·0%; ie, 53·00 mmol/mol), and 49 (38%) of 130 achieved the third trimester HbA1c target (≤6·0 %; ie, 42 mmol/mol). Nine (3%) pregnancy losses were recorded in the first trimester, 20 (8%, including ten stillbirths) in the second trimester, and six (2%) in the third trimester. Main adverse maternal outcomes were procession of diabetic complications (30 [11%] women), pre-eclampsia or eclampsia (47 [18%]), and total pregnancy losses (35 [13%]). Of 230 livebirths, 44 (19%) preterm births, 12 (5%) cardiac congenital malformations, and 18 (8%) early neonatal deaths were recorded. Of 236 infants (230 livebirths and 6 stillbirths in the third trimester), main adverse neonatal outcomes were large for gestational age (68 [29%]) and small for gestational age (12 [5%]); 96 (41%) had to admitted to the neonatal department. Overall, perinatal maternal mortality was 423·73 (95% CI 397·18–451·12) per 100 000 person-years, perinatal neonatal mortality was 55·08% (54·14–56·04), and the incidence of birth defects was 847·45 (835·92–859·05) per 100 000 person-years. Birth defects were the leading cause of neonatal perinatal deaths (10 [29%] of 34). Compared with the general population in China, women with type 1 diabetes did not have increased perinatal maternal mortality (risk ratio 11·76, 95% CI 1·65–83·78; p=0·082), but their infants had significantly higher risks of perinatal mortality (risk ratio 7·58, 95% CI 4·33–13·26; p<0·0001) and birth defects (8·43, 5·33–13·33; p<0·0001). Interpretation Adverse pregnancy outcomes are more frequent in women with type 1 diabetes than in the general population. Management of type 1 diabetes in pregnant women needs to be improved. Funding Chinese National Health and Family Planning Commission Foundation for Public Welfare Industry Research Project (201502011), Sun Yat-Sen University Clinical Research 5010 Program (2007030), and World Diabetes Foundation (WDF14-921). Contributors XZ designed the study, collected and interpreted the data, and wrote the manuscript. JY and DY contributed to the discussion and edited the abstract. SL analysed the data and critically revised the abstract. DZ, XR, JZ, XX, XG, TY, QH, ZZ, FL, JH, JL, JM, XZ, FP, NG, MZ, WL, YY, CF, and HY collected the data, contributed to the discussion, and reviewed the abstract. JW designed the study, interpreted the data, contributed to the discussion, and critically revised the abstract. All authors read and approved the final abstract. Declaration of interests We declare no competing interests.
China (Prof F Liu PhD); Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Soochow University, Suzhou, China (J Hu MD., C Fang MD); and Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China (H Yang PhD) Correspondence to: Prof Jianping Weng, Department of Endocrinology and Metabolism, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China [email protected]
www.thelancet.com/diabetes-endocrinology
Published Online November 17, 2016 Department of Endocrinology and Metabolism, Third Affiliated Hospital of Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Diabetology, Guangdong Diabetes Center, Guangzhou, China (X Zheng MD, J Yan PhD, D Yang MD, S Luo MD, Prof J Weng PhD); Department of Endocrinology and Metabolism, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China (Prof D Zhu PhD,J Lu MD); Department of Endocrinology and Metabolism, West China Second University Hospital, Sichuan University, Chengdu, China (Prof X Ran MD, J Ma MD); Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China (Prof J Zhao PhD, X Zhou MD); Department of Endocrinology and Metabolism, Peking Union Medical College Hospital, Beijing, China (Prof X Xiao MD, F Ping MD); Department of Endocrinology and Metabolism, Peking University First Hospital, Beijing, China (Prof X Guo PhD, N Gu MD); Department of Endocrinology and Metabolism, Jiangsu Province Hospital, Nanjing, China (Prof T Yang PhD, M Zhang MD); Department of Endocrinology and Metabolism, Changhai Hospital, Second Military Medical University, Shanghai, China (Prof Q Huang PhD, W Li MD); Department of Endocrinology and Metabolism, The Second Xiangya Hospital of Central South University, Changsha, China (Prof Z Zhou PhD, Y Yang MD); Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai,
19
Pregnancy outcomes in patients with type 1 diabetes in China: a retrospective study Xueying Zheng, Jinhua Yan, Daizhi Yang, Sihui Luo, Dalong Zhu, Xingwu Ran, Jiajun Zhao, Xinhua Xiao, Xiaohui Guo, Tao Yang, Qin Huang , Zhiguang Zhou, Fang Liu, Ji Hu, Jing Lu, Jing Ma, Xinli Zhou, Fan Ping, Nan Gu, Mei Zhang, Wenwen Li, Yaling Yang, Chen Fang, Huixia Yang, Jianping Weng
Abstract Background Sparse data on pregnancy outcomes for women with type 1 diabetes exist in Chinese women. We aimed to investigate maternal, perinatal, and fetal and neonatal outcomes in women with type 1 diabetes in China. Method We did a retrospective study in 11 hospitals in Beijing, Jinan, Nanjing, Shanghai, Chengdu, Changsha, Guangzhou. We compiled data on pregnancy outcomes of women with type 1 diabetes from anonymised medical records of maternal and infant birth between Jan 1, 2004, to Dec 31, 2014. We analysed perinatal maternal mortality, perinatal neonatal mortality, and perinatal birth defect rate. These outcomes in the general population were estimated from the annual report of national health statistic and the report of birth defects in China. We used χ² or Fisher’s exact test for statistical analyses of categorical data. Ethics approval was granted by all the participating hospitals. Findings We included 289 women with type 1 diabetes with a singleton pregnancy, of whom 26 (9%) had a history of adverse pregnancy outcomes at the start of the study period. At start of pregnancy, mean age was 27·6 years (SD 4·2) and mean diabetes duration was 5·26 years (SD 5·49). Nine women were excluded because of elective terminations and 15 were excluded because no data on pregnancy outcomes were available; thus, 265 women were included in the analysis. In patients with HbA1c records available, 41 (57%) of 72 achieved the preconception HbA1c target (≤7·0%; ie, 53·00 mmol/mol), and 49 (38%) of 130 achieved the third trimester HbA1c target (≤6·0 %; ie, 42 mmol/mol). Nine (3%) pregnancy losses were recorded in the first trimester, 20 (8%, including ten stillbirths) in the second trimester, and six (2%) in the third trimester. Main adverse maternal outcomes were procession of diabetic complications (30 [11%] women), pre-eclampsia or eclampsia (47 [18%]), and total pregnancy losses (35 [13%]). Of 230 livebirths, 44 (19%) preterm births, 12 (5%) cardiac congenital malformations, and 18 (8%) early neonatal deaths were recorded. Of 236 infants (230 livebirths and 6 stillbirths in the third trimester), main adverse neonatal outcomes were large for gestational age (68 [29%]) and small for gestational age (12 [5%]); 96 (41%) had to admitted to the neonatal department. Overall, perinatal maternal mortality was 423·73 (95% CI 397·18–451·12) per 100 000 person-years, perinatal neonatal mortality was 55·08% (54·14–56·04), and the incidence of birth defects was 847·45 (835·92–859·05) per 100 000 person-years. Birth defects were the leading cause of neonatal perinatal deaths (10 [29%] of 34). Compared with the general population in China, women with type 1 diabetes did not have increased perinatal maternal mortality (risk ratio 11·76, 95% CI 1·65–83·78; p=0·082), but their infants had significantly higher risks of perinatal mortality (risk ratio 7·58, 95% CI 4·33–13·26; p<0·0001) and birth defects (8·43, 5·33–13·33; p<0·0001). Interpretation Adverse pregnancy outcomes are more frequent in women with type 1 diabetes than in the general population. Management of type 1 diabetes in pregnant women needs to be improved. Funding Chinese National Health and Family Planning Commission Foundation for Public Welfare Industry Research Project (201502011), Sun Yat-Sen University Clinical Research 5010 Program (2007030), and World Diabetes Foundation (WDF14-921). Contributors XZ designed the study, collected and interpreted the data, and wrote the manuscript. JY and DY contributed to the discussion and edited the abstract. SL analysed the data and critically revised the abstract. DZ, XR, JZ, XX, XG, TY, QH, ZZ, FL, JH, JL, JM, XZ, FP, NG, MZ, WL, YY, CF, and HY collected the data, contributed to the discussion, and reviewed the abstract. JW designed the study, interpreted the data, contributed to the discussion, and critically revised the abstract. All authors read and approved the final abstract. Declaration of interests We declare no competing interests.
China (Prof F Liu PhD); Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Soochow University, Suzhou, China (J Hu MD., C Fang MD); and Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China (H Yang PhD) Correspondence to: Prof Jianping Weng, Department of Endocrinology and Metabolism, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China [email protected]
www.thelancet.com/diabetes-endocrinology
Published Online November 17, 2016 Department of Endocrinology and Metabolism, Third Affiliated Hospital of Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Diabetology, Guangdong Diabetes Center, Guangzhou, China (X Zheng MD, J Yan PhD, D Yang MD, S Luo MD, Prof J Weng PhD); Department of Endocrinology and Metabolism, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China (Prof D Zhu PhD,J Lu MD); Department of Endocrinology and Metabolism, West China Second University Hospital, Sichuan University, Chengdu, China (Prof X Ran MD, J Ma MD); Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China (Prof J Zhao PhD, X Zhou MD); Department of Endocrinology and Metabolism, Peking Union Medical College Hospital, Beijing, China (Prof X Xiao MD, F Ping MD); Department of Endocrinology and Metabolism, Peking University First Hospital, Beijing, China (Prof X Guo PhD, N Gu MD); Department of Endocrinology and Metabolism, Jiangsu Province Hospital, Nanjing, China (Prof T Yang PhD, M Zhang MD); Department of Endocrinology and Metabolism, Changhai Hospital, Second Military Medical University, Shanghai, China (Prof Q Huang PhD, W Li MD); Department of Endocrinology and Metabolism, The Second Xiangya Hospital of Central South University, Changsha, China (Prof Z Zhou PhD, Y Yang MD); Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai,
19