Health care and risk of adverse pregnancy outcomes among diabetic women: an updated meta-analysis

  • Guo-Hong Xie
  • Zan Zheng
  • Tao-Cheng Liu
  • Lu-Lu Qing
  • Xiu-Qin Hong
  • Wen-Ting ZhaEmail author
  • Yuan LvEmail author
Gynecologic Endocrinology and Reproductive Medicine



Diabetic women appear to have adverse pregnancy outcomes. Although there were two meta-analyzes that examined the association between health care and adverse pregnancy outcomes, their results were limited because they only included congenital anomaly and perinatal mortality, and they did not clarify the detailed situations of diabetes and health care. This meta-analysis aims to completely evaluate the effects of health care in improving adverse pregnancy outcomes among diabetic mothers.


CNKI, EMBASE, Web of Science, and PubMed databases were searched for eligible studies up to December 2017, without any restrictions. Relevant cohort studies characterizing the relationship between health care and adverse pregnancy outcomes were selected for inclusion in the meta-analysis. We also screened the reference list of relevant studies. The fixed-effect models or random-effect models were used to calculate the risk estimates. The potential sources of heterogeneity were explored by stratified and sensitivity analyzes.


Twenty-one studies with 6685 cases were included in our analysis. Health care was associated with significantly decreased risk of congenital anomaly (RR 0.237; 95% CI 0.166–0.338), perinatal death (RR 0.457; 95% CI 0.294–0.712), large for gestational age (LGA) (RR 0.794; 95% CI 0.640–0.986), and neonatal hypoglycemia (RR 0.672; 95% CI 0.486–0.929). Publication bias was not found in most results, with the exception of congenital anomaly and small for gestational age (SGA).


Health care is associated with decreased risk of congenital anomaly, perinatal death, LGA, neonatal hypoglycemia.


Adverse outcomes Diabetes Health care Meta-analysis 



We are grateful to everyone who helped us to complete this study successfully.

Author contributions

GX: data collection, data analysis, manuscript writing. ZZ: contributed to the conception. TL: data collection. LQ: data collection. XH: contributed analysis tools. WZ: revised the manuscript. YL: approved the final version.


This work was supported by a Grant from National Natural Science Foundation of China (no: 81773530).

Compliance with ethical standards

Conflict of interest

Author Guohong Xie declares that she has no conflict of interest. Author Zan Zheng declares that he has no conflict of interest. Author Taocheng Liu declares that he has no conflict of interest. Author Lulu Qing declares that she has no conflict of interest. Author Xiuqing Hong declares that she has no conflict of interest. Author Wenting Zha declares that she has no conflict of interest. Author Yuan Lv declares that she has no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Epidemiology and Health Statistics, Key Laboratory of Molecular Epidemiology of Hunan ProvinceMedical College of Hunan Normal UniversityChangshaPeople’s Republic of China
  2. 2.Department of Epidemiology and Health StatisticsXiangYa School of Public HealthChangshaPeople’s Republic of China

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