Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Glycemic control and pregnancy outcomes in women with type 2 diabetes from Poland. The impact of pregnancy planning and a comparison with type 1 diabetes subjects


The number of pregnancies complicated by type 2 diabetes mellitus (T2DM) is growing; however, their clinical characteristics remain incomplete. We aimed to assess clinical characteristics, glycemic control, and selected pregnancy outcomes in pregestational T2DM from Poland and to compare them with those of T1DM. We analyzed 415 consecutive singleton pregnancies; among them, there were 70 women with T2DM and 345 with T1DM. As compared to T1DM patients, women with T2DM were older (mean age 33.1 years vs. 27.8, respectively), heavier before pregnancy (mean BMI 30.8 kg/m² vs. 23.9), and had a shorter duration of diabetes (mean 3.3 years vs. 11.4); ( P < 0.0001 for all comparisons). The gestational age at the first visit was higher in T2DM (mean 11.4 weeks vs. 8.6; P = 0.0004). Nevertheless, they had better glycemic control in the first trimester (mean HbA1c 6.2% vs. 7.0; P = 0.003); in subsequent months, the differences in HbA1c were no longer significant. T2DM women gained less weight during pregnancy (mean 9.9 kgs vs. 14.1; P < 0.0001). The proportion of miscarriages (10.0 vs. 7.3%; P = 0.32), preterm deliveries (12.7 vs. 17.8%; P = 0.32), combined infant deaths, and congenital malformations were similar in both groups (9.5 vs. 8.8%; P = 0.4) as was the frequency of caesarean sections (58.7 vs. 64.1%; P = 0.30). Macrosomic babies were more than twice less frequent in T2DM and the difference reached borderline significance (7.9 vs. 17.5%, P = 0.07). Pregnancy planning in T2DM had a significant impact on HbA1c in the first trimester (5.7 vs. 6.4% in the planning vs. the not planning group, P = 0.02); the difference was not significant in the second and third trimester. T2DM women had better glycemic control in the first trimester than T1DM subjects and gained less weight during pregnancy. This could have been the reason for the slightly lower number of macrosomic babies but did not affect other outcomes. In T2DM, pregnancy planning had a beneficial glycemic effect in the first trimester.

This is a preview of subscription content, log in to check access.

Fig. 1


  1. 1.

    A.H. Mokdad, E.S. Ford, B.A. Bowman, Diabetes trends in the U.S.: 1990–1998. Diabetes Care 23, 1278–1283 (2000)

  2. 2.

    D.S. Feig, V.A. Palda, Type 2 diabetes in pregnancy: a growing concern. Lancet 359, 1690–1692 (2002)

  3. 3.

    S. Hotu, B. Carter, P.D. Watson, W.S. Cutfield, T. Cundy, Increasing prevalence of type 2 diabetes in adolescents. J. Paediatr. Child Health 40, 201–204 (2004)

  4. 4.

    D.S. Feig, A. Razzaq, K. Sykora, J. Hux, G. Anderson, Trends in deliveries, prenatal care, and obstetrical complications in women with pregestational diabetes. A population-based study in Ontario, Canada, 1996–2001. Diabetes Care 29, 232–235 (2006)

  5. 5.

    J.L. Kitzmiller, T.A. Buchanan, S. Kjos, C.A. Combs, R.E. Ratner, Pre-conception care of diabetes, congenital malformations and spontaneous abortions. Diabetes Care 19, 514–541 (1996)

  6. 6.

    I.F. Casson, C. Clarke, C. Howard, O. McKendrick, S. Pennycook, P. Pharoah, M. Platt, M. Stanisstreet, D. van Velszen, S. Walkinshaw, Outcomes of pregnancy in insulin dependent diabetic women: results of a five year population cohort study. BMJ 315, 275–278 (1997)

  7. 7.

    DCCT Investigators, Pregnancy outcomes in the diabetes control and complications trial. Am. J. Obstet. Gynecol. 174, 1343–1353 (1996)

  8. 8.

    K. Remsberg, R. Mckeown, K. Mcfarland, L. Irwin, Diabetes in pregnancy and cesarean delivery. Diabetes Care 22, 1561–1567 (1999)

  9. 9.

    L. Jovanovic, R. Knopp, H. Kim, W. Cefalu, X. Zhu, Y. Lee, J. Simpson, J. Mills, for the diabetes in early pregnancy study group, Elevated pregnancy losses at high and low extremes of maternal glucose in early normal and diabetic pregnancy evidence for a protective adaptation in diabetes. Diabetes Care 28, 1113–1117 (2005)

  10. 10.

    R. Bell, K. Bailey, T. Cresswell, G. Hawthorne, J. Critchley, N. Lewis-Barnede, Trends in prevalence and outcomes of pregnancy in women with pre-existing type I and type II diabetes. BJOG 115, 445–452 (2008)

  11. 11.

    A. Galindo, A. Burguillo, S. Azriel, P. De, la Fuente, Outcome of fetuses in women with pregestational diabetes mellitus. J. Perinat. Med. 34, 323–331 (2006)

  12. 12.

    J.S. Sheffield, E.L. Butler-Koster, B.M. Casey, D.D. McIntire, K.J. Leveno, Maternal diabetes mellitus and infant malformations. Obstet. Gynecol. 100, 925–930 (2002)

  13. 13.

    T. Cundy, G. Gamble, K. Townend, P.G. Henley, P. MacPherson, A.B. Roberts, Perinatal mortality in type 2 diabetes mellitus. Diabet. Med. 17, 33–39 (2000)

  14. 14.

    K. Ylien, P. Aula, U.-H. Stenman, T. Kesaniemi-Kuokkanen, K. Teramo, Risk of minor and major fetal malformations in diabetics with high haemoglobin A1c values in early pregnancy. BMJ 289, 345–347 (1984)

  15. 15.

    L. Suhonen, V. Hiilesmaa, K. Teramo, Glycaemic control during early pregnancy and fetal malfomations in women with type 1 diabetes mellitus. Diabetologia 43, 79–84 (2000)

  16. 16.

    G.C. Penney, G. Mair, D.W. Pearson, The relationship between birth weight and maternal glycated hemoglobin (HbA1c) concentration in pregnancies complicated by Type 1 diabetes. Diabet. Med. 20, 162–166 (2003)

  17. 17.

    H. Murphy, G. Rayman, K. Lewis, S. Kelly, B. Johal, K. Duffield, D. Fowler, P. Campbell, R. Temple, Effectiveness of continuous glucose monitoring in pregnant women with diabetes: randomised clinical trial. BMJ 337, 1680–1688 (2008)

  18. 18.

    E. Stenninger, A. Lindqvist, J. Ĺman, J. Östlund, E. Schvarcz, Continuous subcutaneous glucose monitoring system in diabetic mothers during labour and postnatal glucose adaptation of their infants. Diabet. Med. 25, 450–454 (2008)

  19. 19.

    J. Kitzmiller, J. Block, F. Brown, P. Catalano, D. Conway, D. Coustan, E. Gunderson, W. Herman, L. Hoffman, M. Inturrisi, L. Jovanovic, S. Kjos, R. Knopp, M. Montoro, E. Ogata, P. Paramsothy, D. Reader, B. Rosenn, A. Thomas, S. Kirkman, Managing pre-existing diabetes for pregnancy. Summary of evidence and consensus recommendations for care. Diabetes Care 31, 1060–1079 (2008)

  20. 20.

    M. Balsells, A. Garcia-Patterson, I. Gich, R. Corcoy, Maternal and fetal outcome in women with type 2 versus type 1 diabetes mellitus: a systematic review and metaanalysis. J. Clin. Endocrinol. Metab. 94, 4284–4291 (2009)

  21. 21.

    K. Cyganek, A. Hebda-Szydlo, B. Katra, J. Skupien, T. Klupa, I. Janas, I. Kaim, J. Sieradzki, A. Reron, M.T. Malecki, Glycemic control and selected pregnancy outcomes in type 1 diabetes women on continuous subcutaneous insulin infusion and multiple daily injections: the significance of pregnancy planning. Diabetes Technol. Ther. 12, 41–47 (2010)

  22. 22.

    K. Keppel, S. Taffel, Pregnancy-related weight gain and retention: implications of the 1990 Institute of Medicine guidelines. Am. J. Public Health 83, 1100–1103 (1993)

  23. 23.

    H. de Valk, N. van Nieuwaal, G. Visser, Pregnancy outcome in type 2 diabetes mellitus: a retrospective analysis from the Netherlands. Rev Diabet Stud 3, 134–142 (2006)

  24. 24.

    P. Boulot, N. Chabbert-Buffet, C. Ercole, M. Floriot, P. Fontaine, A. Fournier, J.Y. Gillet, H. Gin, S. Grandperret-Vauthier, A.M. Geudj, B. Guionnet, S. Hauguel-de-Mouzon, S. Hieronimus, M. Hoffet, D. Jullien, M.F. Lamotte, V. Lejeune, J. Lepercq, F. Lorenzi, P. Mares, A. Miton, A. Penfornis, B. Pfister, E. Renard, M. Rodier, P. Roth, G.A. Sery, J. Timsit, A.S. Valat, A. Vambergue, O. Verier-Mine, Diabetes and Pregnancy Group, French multicentric survey of outcome of pregnancy in women with pregestational diabetes. Diabetes Care 26, 2990–2993 (2003)

  25. 25.

    A. Miller, Diabetes: lessons for midwives. Pract Midwife 8, 4–5 (2005)

  26. 26.

    T. Clausen, E. Mathiesen, P. Ekbom, E. Hellmuth, T. Mandrup-Poulsen, P. Damm, Poor pregnancy outcome in women with type 2 diabetes. Diabetes Care 28, 323–328 (2005)

  27. 27.

    A. Lapolla, M. Dalfra, G. Di Cianni, M. Bonomo, E. Parretti, G. Mello, for the Scientific Committee of the GISOGD Group, A multicenter Italian study on pregnancy outcome in women with diabetes. NMCD 18, 291–297 (2008)

  28. 28.

    M.C. Macintosh, K.M. Fleming, J.A. Bailey, P. Doyle, J. Modder, D. Acolet, Perinatal mortality and congenital anomalies in babies of women with type 1 or type 2 diabetes in England, Wales, and Northern Ireland: population based study. BMJ 333, 177 (2006)

  29. 29.

    E. Verheijen, J. Critchley, D. Whitelaw, D. Tuffnella, Outcomes of pregnancies in women with pre-existing type 1 or type 2 diabetes, in an ethnically mixed population. BJOG 112, 1500–1503 (2005)

  30. 30.

    N.L. Gonzales-Gonzales, O. Ramirez, J. Mozas, J. Melchor, H. Armas, J.A. Garcia-Hernandez, A. Caballero, M. Hernandez, M.N. Diaz-Gomez, A. Jimenez, J. Parche, J.L. Bartha, Factors influencing pregnancy outcome in women with type 2 versus type 1 diabetes mellitus. Acta Obset. Gynecol. Scand. 87, 43–49 (2008)

  31. 31.

    F. Dunne, P. Brydon, K. Smith, H. Gee, Pregnancy in women with Type 2 diabetes: 12 years outcome data 1990–2002. Diabet. Med. 20, 734–738 (2003)

  32. 32.

    K. Howorka, J. Pumprla, M. Gabriel, A. Feiks, C. Schlusche, C. Nowotny, E. Schober, T. Waldhoer, M. Langer, Normalization of pregnancy outcome in pregestational diabetes through functional insulin treatment and modular out-patient education adapted for pregnancy. Diabet. Med. 18, 965–972 (2001)

  33. 33.

    C. Mulholland, T. Njoroge, P. Mersereau, J. Williams, Comparison of guidelines available in the United States for diagnosis and management of diabetes before, during, and after pregnancy. J. Womens Health 16(6), 790–801 (2007)

  34. 34.

    American Diabetes Association, Standards of medical care in diabetes—2009. Diabetes Care 32(Suppl 1), S13–S61 (2009)

  35. 35.

    J.D. Walker, NICE guidance on diabetes in pregnancy: management of diabetes, its complications from preconception to the postnatal period. NICE clinical guideline 63. London, March 2008. Diabet. Med. 25(9), 1025–1027 (2008)

  36. 36.

    Polish Diabetes Association, The clinical guidelines in patients with diabetes. Diabetol. Prakt. 11, A38–A43 (2010)

  37. 37.

    N. Holman, N. Lewis-Barned, R. Bell, H. Stephens, J. Modder, J. Gardosi, A. Dornhorst, R. Hillson, B. Young, HR. Murphy, on behalf of the NHS Diabetes in Pregnancy Dataset Development Group, Development and evaluation of a standardized registry for diabetes in pregnancy using data from the Northern, North West and East Anglia regional audits. Diabet. Med. (2011) [Epub ahead of print]

  38. 38.

    M. Hod, Y. Yogev, Goals of metabolic management of gestational diabetes. Diabetes Care 30(Suppl 2), S180–S187 (2007)

  39. 39.

    J. Roland, H. Murphy, V. Ball, J. Northcote-Wright, R. Temple, The pregnancies of women with Type 2 diabetes: poor outcomes but opportunities for improvement. Diabet. Med. 22, 1774–1777 (2005)

  40. 40.

    J. Kristensen, M. Vestergaard, K. Wisborg, U. Kesmodel, N. Jørgen, Pre-pregnancy weight and the risk of stillbirth and neonatal death. BJOG 112, 403–408 (2005)

  41. 41.

    H. Ehrenberg, B. Mercer, P. Catalano, The influence of obesity and diabetes on the prevalence of macrosomia. AJOG 191, 964–968 (2004)

  42. 42.

    W. Ricart, J. López, J. Mozas, A. Pericot, M.A. Sancho, N. González, M. Balsells, R. Luna, A. Cortázar, P. Navarro, O. Ramírez, B. Flández, L.F. Pallardo, A. Hernández, J. Ampudia, J.M. Fernández-Real, R. Corcoy, Spanish Group for the Study of the Impact of Carpenter, Coustan GDM thresholds, Body mass index has a greater impact on pregnancy outcomes than gestational hyperglycaemia. Diabetologia 48, 1736–1742 (2005)

  43. 43.

    I. Thorsdottir, J. Torfadottir, B. Birgisdottir, R. Geirsson, Weight gain in women of normal weight before pregnancy: complications in pregnancy or delivery and birth outcome. Obstet. Gynecol. 99, 799–806 (2002)

  44. 44.

    J.G. Ray, T.E. O’Brien, W.S. Chan, Preconception care and the risk of congenital anomalies in the offspring of women with diabetes mellitus: a meta-analysis. Q. J. Med. 94, 435–444 (2001)

  45. 45.

    H.R. Murphy, J.M. Roland, T.C. Skinner, D. Simmons, E. Gurnell, N.J. Morrish, S.C. Soo, S. Kelly, B. Lim, J. Randall, S. Thompsett, R.C. Temple, Effectiveness of a regional prepregnancy care program in women with type 1 and type 2 diabetes: benefits beyond glycemic control. Diabetes Care 33(12), 2514–2520 (2010)

  46. 46.

    D. Farrar, D.J. Tuffnell, J. West, Continuous subcutaneous insulin infusion versus multiple daily injections of insulin for pregnant women with diabetes. Cochrane Database Syst. Rev. 3, 89–94 (2007)

  47. 47.

    M.A. Mondestin, C.V. Ananth, J.C. Smulian, A.M. Vintzileos, Birth weight and fetal death in the United States: the effect of maternal diabetes during pregnancy. Am. J. Obstet. Gynecol. 187, 922–926 (2002)

  48. 48.

    A.R. Humphrey, D.J. McCarty, I.R. Mackay, M.J. Rowley, T. Dwyer, P. Zimmet, Autoantibodies to glutamic acid decarboxylase and phenotypic features associated with early insulin treatment in individuals with adult-onset diabetes mellitus. Diabet. Med. 15, 113–119 (1998)

Download references


This study was supported by the Polish Ministry of Science Grant No. N N407 414436 and by the Jagiellonian University Medical College. The authors would like to express their gratefulness to The Great Orchestra of Christmas Charity; a non-governmental aid organization in Poland, which provided help in medical care to many women participating in this study.

Author information

Correspondence to Maciej T. Malecki.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Cyganek, K., Hebda-Szydlo, A., Skupien, J. et al. Glycemic control and pregnancy outcomes in women with type 2 diabetes from Poland. The impact of pregnancy planning and a comparison with type 1 diabetes subjects. Endocrine 40, 243 (2011).

Download citation


  • Pregnancy
  • Type 2 diabetes
  • Type 1 diabetes
  • Outcomes