Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2006

Open Access 01-12-2006 | Research article

Poor glycated haemoglobin control and adverse pregnancy outcomes in type 1 and type 2 diabetes mellitus: Systematic review of observational studies

Authors: Melanie E Inkster, Tom P Fahey, Peter T Donnan, Graham P Leese, Gary J Mires, Deirdre J Murphy

Published in: BMC Pregnancy and Childbirth | Issue 1/2006

Login to get access

Abstract

Background

Glycaemic control in women with diabetes is critical to satisfactory pregnancy outcome. A systematic review of two randomised trials concluded that there was no clear evidence of benefit from very tight versus tight glycaemic control for pregnant women with diabetes.

Methods

A systematic review of observational studies addressing miscarriage, congenital malformations and perinatal mortality among pregnant women with type 1 and type 2 diabetes was carried out. Literature searches were performed in MEDLINE, EMBASE, CINAHL and Cochrane Library. Observational studies with data on glycated haemoglobin (HbA1c) levels categorised into poor and optimal control (as defined by the study investigators) were selected. Relative risks and odds ratios were calculated for HbA1c and pregnancy outcomes. Adjusted relative risk estimates per 1-percent decrease in HbA1c were calculated for studies which contained information on mean and standard deviations of HbA1c.

Results

The review identified thirteen studies which compared poor versus optimal glycaemic control in relation to maternal, fetal and neonatal outcomes. Twelve of these studies reported the outcome of congenital malformations and showed an increased risk with poor glycaemic control, pooled odds ratio 3.44 (95%CI, 2.30 to 5.15). For four of the twelve studies, it was also possible to calculate a relative risk reduction of congenital malformation for each 1-percent decrease in HbA1c, these varied from 0.39 to 0.59. The risk of miscarriage was reported in four studies and was associated with poor glycaemic control, pooled odds ratio 3.23 (95%CI, 1.64 to 6.36). Increased perinatal mortality was also associated with poor glycaemic control, pooled odds ratio 3.03 (95%CI, 1.87 to 4.92) from four studies.

Conclusion

This analysis quantifies the increase in adverse pregnancy outcomes in women with diabetes who have poor glycaemic control. Relating percentage risk reduction in HbA1c to relative risk of adverse pregnancy events may be useful in motivating women to achieve optimal control prior to conception.
Appendix
Available only for authorised users
Literature
1.
Hawthorne G, Modder J: Maternity Services for Women With Diabetes in the UK. Diabetic Medicine. 2002, 19 (Suppl 4): 50-5. 10.1046/j.1464-5491.19.s4.10.x.CrossRefPubMed
2.
Casson IF, Clarke CA, Howard CV, McKendrick O, Pennycook S, Pharoah PO, Platt MJ, Stanisstreet M, van Velszen D, Walkinshaw S: Outcomes of Pregnancy in Insulin Dependent Diabetic Women: Results of a Five Year Population Cohort Study. BMJ. 315: 275-8. 2-8-1997
3.
Hawthorne G, Robson S, Ryall EA, Sen D, Roberts SH, Ward Platt MP: Prospective Population Based Survey of Outcome of Pregnancy in Diabetic Women: Results of the Northern Diabetic Pregnancy Audit, 1994. BMJ. 315: 279-81. 2-8-1997
4.
Hawthorne G, Irgens LM, Lie RT: Outcome of Pregnancy in Diabetic Women in Northeast England and in Norway, 1994–7. BMJ. 321: 730-1. 10.1136/bmj.321.7263.730. 23-9-2000
5.
Janz NK, Herman WH, Becker MP, Charron-Prochownik D, Shayna VL, Lesnick TG, Jacober SJ, Fachnie JD, Kruger DF, Sanfield JA: Diabetes and Pregnancy. Factors Associated With Seeking Pre-Conception Care. Diabetes Care. 1995, 18 (2): 157-65.CrossRefPubMed
6.
Martin FIR, Heath P, Mountain KR: Pregnancy in Women With Diabetes Mellitus. Fifteen Years' Experience: 1970–1985. Medical Journal of Australia. 1987, 146 (4):
7.
Temple R, Aldridge V, Greenwood R, Heyburn P, Sampson M, Stanley K: Association Between Outcome of Pregnancy and Glycaemic Control in Early Pregnancy in Type 1 Diabetes: Population Based Study. BMJ. 2002, 325: 1275-6. 10.1136/bmj.325.7375.1275.CrossRefPubMedPubMedCentral
8.
Platt MJ: St Vincent's Declaration 10 Years on: Outcomes of Diabetic Pregnancies. Diabetic Medicine. 2002, 19 (3): 216-20. 10.1046/j.1464-5491.2002.00665.x.CrossRefPubMed
9.
Goldstein DE, Little RR, Lorenz RA, Malone JI, Nathan D, Peterson CM, Sacks DB: Tests of Glycemia in Diabetes. Diabetes Care. 2004, 27 (7): 1761-73.CrossRefPubMed
10.
Rosenn B, Miodovnik M, Dignan PS, Siddiqi TA, Khoury J, Mimouni F: Minor Congenital Malformations in Infants of Insulin-Dependent Diabetic Women: Association With Poor Glycemic Control. Obstetrics & Gynecology. 1990, 76 (5 Pt 1): 745-9.CrossRef
11.
Rosenn B, Miodovnik M, Combs CA, Khoury J, Siddiqi TA: Glycemic Thresholds for Spontaneous Abortion and Congenital Malformations in Insulin-Dependent Diabetes Mellitus. Obstetrics & Gynecology. 1994, 84 (4): 515-20.
12.
Greenland S: Quantitative Methods in the Review of Epidemiologic Literature. Epidemiologic Reviews. 1987, 9: 1-30.PubMed
13.
14.
15.
Gestation and Diabetes in France Study Group: Multicenter Survey of Diabetic Pregnancy in France. Gestation and Diabetes in France Study Group. Diabetes Care. 1991, 14 (11): 994-1000.CrossRef
16.
Evers IM, de Valk HW, Visser GH: Risk of Complications of Pregnancy in Women With Type 1 Diabetes: Nationwide Prospective Study in the Netherlands. BMJ. 2004, 328: 915-10.1136/bmj.38043.583160.EE.CrossRefPubMedPubMedCentral
17.
Hiilesmaa V, Suhonen L, Teramo K: Glycaemic Control Is Associated With Pre-Eclampsia but Not With Pregnancy-Induced Hypertension in Women With Type I Diabetes Mellitus. Diabetologia. 2000, 43 (12): 1534-9. 10.1007/s001250051565.CrossRefPubMed
18.
Miller E, Hare JW, Cloherty JP, Dunn PJ, Gleason RE, Soeldner JS, Kitzmiller JL: Elevated Maternal Hemoglobin A1c in Early Pregnancy and Major Congenital Anomalies in Infants of Diabetic Mothers. New England Journal of Medicine. 1981, 304 (22): 1331-4.CrossRefPubMed
19.
Key TC, Giuffrida R, Moore TR: Predictive Value of Early Pregnancy Glycohemoglobin in the Insulin-Treated Diabetic Patient. American Journal of Obstetrics & Gynecology. 1987, 156 (5): 1096-100.CrossRef
20.
Wender-Ozegowska E, Wroblewska K, Zawiejska A, Pietryga M, Szczapa J, Biczysko R: Threshold Values of Maternal Blood Glucose in Early Diabetic Pregnancy – Prediction of Fetal Malformations. Acta Obstetricia et Gynecologica Scandinavica. 2005, 84 (1): 17-25. 10.1111/j.0001-6349.2005.00606.x.CrossRefPubMed
21.
Ylinen K, Aula P, Stenman UH, Kesaniemi-Kuokkanen T, Teramo K: Risk of Minor and Major Fetal Malformations in Diabetics With High Haemoglobin A1c Values in Early Pregnancy. British Medical Journal Clinical Research Ed. 1984, 289 (6441): 345-6.CrossRefPubMedPubMedCentral
22.
Kitzmiller JL, Gavin LA, Gin GD, Jovanovic-Peterson L, Main EK, Zigrang WD: Preconception Care of Diabetes. Glycemic Control Prevents Congenital Anomalies. JAMA. 265 (6): 731-6. 10.1001/jama.265.6.731. 13-2-1991
23.
Greene MF, Hare JW, Cloherty JP, Benacerraf BR, Soeldner JS: First-Trimester Hemoglobin A1 and Risk for Major Malformation and Spontaneous Abortion in Diabetic Pregnancy. Teratology. 1989, 39 (3): 225-31. 10.1002/tera.1420390303.CrossRefPubMed
24.
Hanson U, Persson B, Thunell S: Relationship Between Haemoglobin A1C in Early Type 1 (Insulin-Dependent) Diabetic Pregnancy and the Occurrence of Spontaneous Abortion and Fetal Malformation in Sweden. Diabetologia. 1990, 33 (2): 100-4. 10.1007/BF00401047.CrossRefPubMed
25.
CEMACH: Confidential Enquiry into Maternal and Child Health: Pregnancy in Women with Type 1 and Type 2 Diabetes in 2002–03, England, Wales and Northern Ireland. London. 2005
26.
Vaarasmaki MS, Hartikainen A, Anttila M, Pramila S, Koivisto M: Factors Predicting Peri- and Neonatal Outcome in Diabetic Pregnancy. Early Human Development. 2000, 59 (1): 61-70. 10.1016/S0378-3782(00)00087-6.CrossRefPubMed
27.
Walkinshaw SA: Very Tight Versus Tight Control for Diabetes in Pregnancy. Cochrane Database of Systematic Reviews. 2000, CD000226-2
28.
The Diabetes Control and Complications Trial Research Group: The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-Term Complications in Insulin-Dependent Diabetes Mellitus. The Diabetes Control and Complications Trial Research Group. New England Journal of Medicine. 1993, 329 (14): 977-86. 10.1056/NEJM199309303291401.CrossRef
29.
Penney GC, Mair G, Pearson DW, Scottish Diabetes in Pregnancy, Group: Outcomes of Pregnancies in Women With Type 1 Diabetes in Scotland: a National Population-Based Study. BJOG: an International Journal of Obstetrics & Gynaecology. 2003, 110 (3): 315-8. 10.1046/j.1471-0528.2003.02067.x.CrossRef
30.
Dokken B, Johnson D: The Importance of Reaching Preconception Targets for Glycemic Control in Diabetic Women. Archives of Internal Medicine. 1998, 158 (12): 1299-300. 10.1001/archinte.158.12.1299.CrossRefPubMed
31.
Nielsen GL, Sorensen HT, Nielsen PH, Sabroe S, Olsen J: Glycated Hemoglobin As Predictor of Adverse Fetal Outcome in Type 1 Diabetic Pregnancies. Acta Diabetologica. 1997, 34 (3): 217-22. 10.1007/s005920050077.CrossRefPubMed
32.
Ray JG, O'Brien TE, Chan WS: Preconception Care and the Risk of Congenital Anomalies in the Offspring of Women With Diabetes Mellitus: a Meta-Analysis. QJM. 2001, 94 (8): 435-44. 10.1093/qjmed/94.8.435.CrossRefPubMed
33.
Casele HL, Laifer SA: Factors Influencing Preconception Control of Glycemia in Diabetic Women. Archives of Internal Medicine. 1998, 158 (12): 1321-4. 10.1001/archinte.158.12.1321.CrossRefPubMed
34.
Linn T, Bretzel RG: Diabetes in Pregnancy. European Journal of Obstetrics, Gynecology, & Reproductive Biology. 1997, 75 (1): 37-41. 10.1016/S0301-2115(97)00194-2.CrossRef
Metadata
Title
Poor glycated haemoglobin control and adverse pregnancy outcomes in type 1 and type 2 diabetes mellitus: Systematic review of observational studies
Authors
Melanie E Inkster
Tom P Fahey
Peter T Donnan
Graham P Leese
Gary J Mires
Deirdre J Murphy
Publication date
01-12-2006
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2006
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/1471-2393-6-30

Other articles of this Issue 1/2006

BMC Pregnancy and Childbirth 1/2006 Go to the issue

Study protocol

Maternal health study: a prospective cohort study of nulliparous women recruited in early pregnancy

Erratum

Erratum to: The DiAMOND trial protocol: A randomised controlled trial of two decision aids for mode of delivery among women with a previous caesarean section [ISRCTN84367722]

Research article

Home delivery and newborn care practices among urban women in western Nepal: a questionnaire survey

Study protocol

Study protocol: a double blind placebo controlled trial examining the effect of domperidone on the composition of breast milk [NCT00308334]

Research article

Human papillomavirus in amniotic fluid

Research article

Absorbing and transferring risk: assessing the impact of a statewide high-risk-pregnancy telemedical program on VLBW maternal transports