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Pregnancy outcomes and maternal characteristics in women with pregestational and gestational diabetes: a retrospective study on 206,917 singleton live births

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Abstract

Aims

To examine risk of adverse pregnancy outcomes, mothers’ characteristics and incidence rate over time of pregestational type 1 (T1D), type 2 (T2D) or gestational diabetes (GDM).

Methods

The study included all singleton live births born from women aged 15–45 year, in Tuscany, Italy from 2010 to 2018. Pregnancy outcomes were retrieved by certificates of care at delivery compiled by midwives. Pregestational diabetes and GDM were identified by regional administrative databases. Time course of pregestational diabetes and GDM across last decade was assessed by Poisson analysis. Logistic regression analysis was used to calculate adjusted odds ratios (OR; 95% CI) for maternal characteristics or neonatal outcomes.

Results

Among 206,917 singleton live births, GDM was diagnosed in 21,613 pregnancies (10.46%) and pregestational diabetes in 979, being T2D more prevalent than T1D (606; 0.29% vs. 373; 0.18%). Pregestational T2D incidence progressively decreased over last decade, T1D remained stable while GDM progressively rose. Pre-pregnancy obesity, preterm deliveries or cesarean sections were common characteristics of pregestational diabetes and GDM. Risk of neonatal distress and neonatal malformations was higher in pregestational T1D. Risk of prior spontaneous abortions was higher in GDM and in pregestational T2D (OR: 4.19; 3.30–5.33), mostly treated with metformin. Risk of neonatal macrosomia was increased only in pregestational diabetes.

Conclusions

In our population, pregestational T2D was more prevalent than T1D. Neonatal complications were mostly associated with pregestational T1D. Increased risk of previous spontaneous abortions was the hallmark of pregestational T2D. GDM, even if sharing adverse outcomes with pregestational T2D, was unrelated to rise in risk of neonatal macrosomia.

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Author information

Authors and Affiliations

  1. Epidemiology Unit, Regional Health Agency of Tuscany, Via Pietro Dazzi 1, 50141, Florence, Italy

    Elisa Gualdani, Paolo Francesconi & Giuseppe Seghieri

  2. Diabetes and Metabolic Diseases Unit, Health Local Unit North-West Tuscany, Livorno, Italy

    Graziano Di Cianni

  3. Diabetes and Metabolic Diseases Unit, “San Giovanni Di Dio” Hospital, Florence, Italy

    Marta Seghieri

Authors
  1. Elisa Gualdani
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  2. Graziano Di Cianni
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  3. Marta Seghieri
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  4. Paolo Francesconi
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  5. Giuseppe Seghieri
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Contributions

No potential conflicts of interest relevant to this article were reported. E.G. and G.S. conducted the data analysis, G.D.C. and P.F. developed the study protocol and contributed to discussion. G.S. and M.S. wrote and edited the final manuscript.

Corresponding author

Correspondence to Giuseppe Seghieri.

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Conflict of interest

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Human and animal rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Informed consent

Each patient was assigned a unique identifier that was the same for all administrative databases. This identifier does not allow to disclose the patient’s identity and other sensitive data and therefore no informed consent was required from all patients for being included in the study.

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This article belongs to the topical collection Pregnancy and Diabetes, managed by Antonio Secchi and Marina Scavini.

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Gualdani, E., Di Cianni, G., Seghieri, M. et al. Pregnancy outcomes and maternal characteristics in women with pregestational and gestational diabetes: a retrospective study on 206,917 singleton live births. Acta Diabetol 58, 1169–1176 (2021). https://doi.org/10.1007/s00592-021-01710-0

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  • DOI: https://doi.org/10.1007/s00592-021-01710-0

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