Pregnancy complications and perinatal outcomes associated with maternal diabetes

STUDIES A SPECIAL REPORT SERIES ВУ THE N.C. DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES STATE CENTER FOR HEALTH AND ENVIRONMENTAL STATISTICS P.O. BOX 29538, RALEIGH, N.C. 276264538 No. 73 May 1993 PREGNANCY COMPLICATIONS AND PERINATAL OUTCOMES ASSOCIATED WITH MATERNAL DIABETES by Robert E Meyer, PhD1 Paul A, Buescher, PhD1 Kevin Ryan, MD, MPH2 ABSTRACT This study examines the risk for maternal complications and adverse outcomes among a cohort of 6,092 diabetic (insulin-dependent and non-insulin-dependent) and 13,653 nondiabetic gravidas deliver¬ ing in North Carolina in 1989-1 990. Data on maternal diabetes and pregnancy outcome were obtained from matched live birth and infant death certificates. Controlling for maternal age, race, education, maritalstatus, parity, smoking, and amount of prenatal care, mothers with diabetes were more likely to have had complications of polyhydramnios, pregnancy- induced hypertension, eclampsia, cephalopelvic disproportion, breech presentation and preterm deliv¬ ery. Infants of diabetic mothers were more likely to weigh 4,000 grams or more at delivery and to experience birth injury and intrapartum hypoxemia. Controlling for birth weight, the risk for neonatal and postneonatal mortality among infants of diabetics was more than two times that of infants whose mothers were nondiabetic. Congenital malformations accounted for 31 .3 percent of the deaths among infants of diabetic mothers, compared to 11.6 percent of the deaths among infants of nondiabetics. These findings indicate that diabetes is associated with a wide spectrum of maternal and perinatal complications. Appropriate preconceptional care, improved prenatal diagnosis, better metabolic control, and careful obstetric management of mothers with diabetes can substantially reduce the risk for many of these conditions. ‘Slate Center for Health and Environmental Statistics, North Carolina Department of Environment, Health, and Natural Resources JDi vision of Maternal and Child Health, North Carolina Department of Environment, Health, and Natural Resources