Pregnancy outcome in women with type 1 and type 2 diabetes mellitus in Dubai hospital: A retrospective observational study

Abstract

Aim and Objectives: Pregestational diabetes mellitus (PGDM) affects less than 1% of the obstetric population. It has a significant impact on maternal and fetal morbidity and mortality. This study aimed at evaluating antenatal care and pregnancy outcomes in women with PGDM who delivered in Dubai Hospital during 2017–2019. Materials and Methods: A retrospective analysis of all women with diabetes mellitus who delivered in a tertiary care hospital at Dubai from January 1, 2017, to December 31, 2019, was conducted. Maternal characteristics, type of diabetes mellitus, prepregnancy and antenatal glycemic control, mode of delivery, birth weight, and perinatal outcomes were evaluated during the study period. We also compared glycated hemoglobin (HbA1c) levels prepregnancy and during the antenatal period in type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM), with its impact on maternal and fetal outcomes. Results: There were 7284 women who delivered during the study period at our hospital, out of whom 28 women (18.8%) had T1DM and 121 women (81.2%) had T2DM. A total of 144 (96.6%) patients were booked in the antenatal-diabetes mellitus combined clinic. Seventy-nine (53%) women had measured HbA1c within six months before pregnancy. Only 53% women preconceptionally had HbA1c levels <6.5%; however, by the third trimester, 74% of women achieved HbA1c <6.5%. Antenatally, 26 women were associated with essential hypertension, 10 with nephropathy, and eight with retinopathy and 12 women developed preeclampsia. Forty-six (30%) women had preterm delivery at less than 37 weeks. This was significantly higher in T1DM versus T2DM (50% vs. 27%, P value = 0.01). The cesarean section rate was 62%, and 50% of them were due to repeat elective cesarean section. Twelve babies born were more than 4kg, and one of them weighed more than 5kg (5.270kg). There were five cases with stillbirth, no neonatal death was recorded within seven days, and the perinatal mortality rate was 30/1000. Conclusion: The interval prevalence of PGDM in our cohort was 2%. Achieving HbA1c levels <6.5% in two-third of the women with diabetes mellitus by the third trimester resulted in a prevalence of macrosomia (8%) similar to the general population.

Keywords

• glycated hemoglobin (hba1c)
• maternal morbidity
• perinatal mortality
• pregestational diabetes mellitus (pgdm)