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Outcomes in Type 1 Diabetic Pregnancies
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OBJECTIVE—The aim of this study was to compare pregnancy outcomes in type 1 diabetic pregnancies with the background population. RESEARCH DESIGN AND METHODS—This nationwide prospective multicenter study took place in eight Danish centers treating pregnant women with type 1 diabetes during 1993–1999. A total of 990 women with 1,218 pregnancies and delivery after 24 weeks (n = 1,215) or early termination due to severe congenital malformations (n = 3) were included. Data were collected prospectively by one to three caregivers in each center and reported to a central registry. RESULTS—The perinatal mortality rate was 3.1% in type 1 diabetic pregnancies compared with 0.75% in the background population (RR 4.1 [95% CI 2.9–5.6]), and the stillbirth rate was 2.1% compared with 0.45 (4.7 [3.2–7.0]). The congenital malformation rate was 5.0% in the study population and 2.8% (1.7 [1.3–2.2]) in the background population. Six of the perinatal deaths (16%) were related to congenital malformations. Only 34% of women performed daily home monitoring of blood glucose at conception, and 58% received preconceptional guidance. Pregnancies with serious adverse outcomes (perinatal death and/or congenital malformations) were characterized by higher HbA1c values before and during pregnancy and a lesser degree of maternal self-care and preconceptional guidance. Women who performed daily self-monitoring of blood glucose at any time during pregnancy had lower HbA1c values than women who did not measure their daily profile. Likewise, daily self-monitoring was associated with a reduction in serious adverse outcomes. The caesarean section rate was 55.9 and 12.6%, respectively, and the risk of preterm delivery was 41.7 and 6.0%, respectively. CONCLUSIONS—Type 1 diabetic pregnancies are still complicated by considerably higher rates of severe perinatal complications compared with the background population, and women with poor self-care are at the highest risk. Adequate glycemic control using daily glucose monitoring before and during pregnancy is a crucial step toward reaching the goals of the St. Vincent declaration.
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“Overall, studies have shown that treatment including a basal insulin regimen resulted in better glycemic control compared with sliding-scale insulin alone.92,107–109”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [109]
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Metadata
- Authors
- Jensen, D. M., Damm, P., Moelsted-Pedersen, L., Ovesen, P., Westergaard, J. G., Moeller, M., & Beck-Nielsen, H.
- Affiliations
- Odense University Hospital (DK)
- University of Copenhagen (DK)
- Department of Obstetrics and Gynaecology, Copenhagen County Hospital, Glostrup, University of Copenhagen, Copenhagen, Denmark
- Aarhus University Hospital (DK)
- University of Southern Denmark (DK)
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2004-12-01
- Volume
- 27
- Issue
- 12
- Pages
- 2819-2823
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W1978110501
- Cited by
- 486
- References
- 14
- Citations by year
- 2026: 9 · 2025: 6 · 2024: 16 · 2023: 12 · 2022: 16 · 2021: 18 · 2020: 15 · 2019: 17 · 2018: 19 · 2017: 74 · 2016: 21 · 2015: 17 · 2014: 23 · 2013: 28 · 2012: 27
- FWCI
- 17.64
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion, other-oa)
- Funders
- Diabetesforeningen
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- type 1 diabetes in pregnancy, perinatal mortality, stillbirth, congenital malformations, glycemic control, HbA1c, self-monitoring of blood glucose, maternal self-care, cesarean section, preterm birth, St. Vincent Declaration
- MeSH terms
- Congenital Abnormalities, Denmark, Female, Gestational Age, Humans, Infant, Newborn, Jaundice, Pregnancy, Pregnancy Complications, Pregnancy Outcome, Respiratory Distress Syndrome, Newborn, Diabetes, Gestational, Diabetes Complications
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