Stillbirth Risk & Diabetes: Could Earlier Delivery Help?

Nicky Broyd

July 30, 2019

A Scottish study adds new evidence to the known increased risk of stillbirth for women with diabetes, and suggests delivery before term could be "an attractive option".

The research team from the University of Glasgow Institute of Cardiovascular and Medical Sciences also highlights obesity and unmanaged blood sugar levels as risk factors. The findings are reported in Diabetologia , the journal of the European Association for the Study of Diabetes.

Scottish Morbidity Record

Using data from the Scottish Morbidity Record linked to the Scottish Care Information-Diabetes (SCI-Diabetes) database, the records of 5392 singleton babies born to 3847 mothers with diabetes between April 1998 and June 2016 were analysed.

Of these:

Stillbirth rates were:

  • 16.1 per 1000 births in type 1 diabetes

  • 22.9 per 1000 births in type 2 diabetes

That compares with 4.9 per 1000 births in the general population.

The increased stillbirth risk with higher pregnancy blood glucose levels with type 1 diabetes was consistent with previous research.

However, for women with type 2 diabetes, levels before pregnancy were more of a stillbirth risk factor than levels during pregnancy.

As expected, higher maternal BMI was an independent stillbirth risk factor.

A gender risk was identified, with 81% of stillborn infants delivered to mothers with type 2 diabetes being male. Male foetuses are known to be more at-risk in utero.

No significant differences were seen linked to other factors, such as use of different hospitals or clinics, or socio-economic status.

Better Support, Earlier Delivery Options

The study authors conclude: "Achievement of near normoglycaemia remains key to reducing risk. Methods of supporting women to improve blood glucose levels in pregnancy along with programmes to optimise weight before pregnancy may help reduce stillbirth rates but are often challenging to implement successfully."

Previous research has highlighted stillbirth risk with diabetes at full-term to be at least five times higher than the general population. In this latest study a third of stillbirths occurred at term.

National Institute for Health and Care Excellence (NICE) guidance for England already suggests offering induction or caesarean section during the 37thor 38th week of pregnancy for women with type 1 or type 2 diabetes. In Scotland, guidelines recommend delivery between the 38th to 40th week. In the US, it is in the 39th week.

The study authors note that: "Optimal timing of delivery in diabetes remains controversial." However, they wrote "until more accurate assessment of risk during pregnancy becomes available, earlier delivery may be considered an attractive option."

They do note that the advantages of earlier delivery do have to be balanced with other risks, including neonatal respiratory distress syndrome.

Reacting to the findings in a statement, Dr Emily Burns, head of research communications at Diabetes UK, said that "this research reinforces the importance of supporting women to manage their blood glucose levels if they are planning a pregnancy, in order to reduce their risk of complications as much as possible.

"It also suggests that losing extra weight, for women with type 2 diabetes who are overweight, could help to reduce this risk as well.

"We need research to find better ways of predicting who is most at risk of complications during pregnancy, to ensure support can be provided to those who need it most."

Factors associated with stillbirth in women with diabetes. Diabetologia.  https://doi.org/10.1007/s00125-019-4943-9

The study received funding from the Scottish Diabetes Research Network Epidemiology Group.

The authors report no conflict of interest in the presentation of their manuscript.

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