LAUSR

The obstetric and neonatal risk of complications in patients with diabetes are well recognised to be significantly higher compared with those without diabetes. A new study published in The BMJ provided further up-to-date supportive evidence that pregnant women with type 1 diabetes are at increased risk of premature birth. Although this risk increases with higher HbA1c levels (~8%-9%), women who maintain their HbA1c (below 6.5%) unfortunately also remain at an increased risk of giving birth prematurely. The study involved linking the Swedish Medical Birth Register (MFR) to the Swedish National Diabetes Register (NDR) for the years 2003 to 2014. Two thousand four hundred and seventy four infants born to women who recorded long-term HbA1c levels during pregnancy were identified and were compared to 1.16 million infants born to women without diabetes. The study observed that ~22% of infants born to women with type 1 diabetes were born prematurely, compared to less than 5% of infants born to women without type 1 diabetes. Further, 37% of women with type 1 diabetes and an HbA1c level of >9% developed premature birth and 13% of patient with optimal HbA1c (<6.5%) developed early labour. This is the first large study to demonstrate a clear relationship between HbA1c levels and preterm birth. The study also found an increased risk of these newborns being “large for gestational age,” being injured during childbirth, experiencing respiratory problems, hypoglycaemia, birth asphyxia, as well as higher neonatal mortality rates and still birth amongst those with greater HbA1c levels. Much still needs to be done to prevent the increased risk of perinatal and post-natal complications of diabetes.