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Undiagnosed type 2 diabetes during pregnancy is associated with increased perinatal mortality: a large population-based cohort study in Ontario, Canada.
Lee, D; Booth, G L; Ray, J G; Ling, V; Feig, D S.
Afiliação
  • Lee D; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
  • Booth GL; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
  • Ray JG; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
  • Ling V; ICES, Toronto, Ontario, Canada.
  • Feig DS; Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
Diabet Med ; 37(10): 1696-1704, 2020 10.
Article em En | MEDLINE | ID: mdl-31994233
AIM: To compare perinatal outcomes in women with undiagnosed diabetes with gestational diabetes alone, pre-existing diabetes and women without diabetes, and to identify risk factors which distinguish them from women with gestational diabetes alone. METHODS: This population-based cohort study included administrative data on all women who gave birth in Ontario, Canada, during 2002-2015. Maternal/neonatal outcomes were compared across groups using logistic regression, adjusting for confounders. A nested case control study compared women with undiagnosed type 2 diabetes with women with gestational diabetes alone to determine risk factors that would help identify these women. RESULTS: Among 995 990 women, 68 163 had gestational diabetes (6.8%) and, of those women with gestational diabetes,1772 had undiagnosed type 2 diabetes (2.6%). Those with undiagnosed type 2 diabetes were more likely to be older, from a lower income area, have parity > 3 and BMI ≥ 30 kg/m2 compared with gestational diabetes alone. Infants had a higher risk of perinatal mortality (OR 2.3 [1.6-3.4]), preterm birth (OR 2.6 [2.3-2.9]), congenital anomalies (OR 2.1 [1.7-2.5]), neonatal intensive care unit admission (OR 3.1 [2.8-3.5]) and neonatal hypoglycaemia (OR 406.0 [357-461]), which were similar to women with pre-existing diabetes. The strongest predictive risk factors included early gestational diabetes diagnosis, previous gestational diabetes and chronic hypertension. CONCLUSIONS: Women diagnosed with gestational diabetes who develop diabetes within 1 year postpartum are at higher risk of adverse pregnancy outcomes, including perinatal mortality. This highlights the need for earlier diagnosis, preferably pre-pregnancy, and more aggressive treatment and surveillance of suspected type 2 diabetes during pregnancy.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Gravidez em Diabéticas / Anormalidades Congênitas / Diabetes Gestacional / Nascimento Prematuro / Diabetes Mellitus Tipo 2 / Mortalidade Perinatal / Doenças não Diagnosticadas Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adolescent / Adult / Female / Humans / Middle aged / Newborn / Pregnancy País/Região como assunto: America do norte Idioma: En Ano de publicação: 2020 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Gravidez em Diabéticas / Anormalidades Congênitas / Diabetes Gestacional / Nascimento Prematuro / Diabetes Mellitus Tipo 2 / Mortalidade Perinatal / Doenças não Diagnosticadas Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adolescent / Adult / Female / Humans / Middle aged / Newborn / Pregnancy País/Região como assunto: America do norte Idioma: En Ano de publicação: 2020 Tipo de documento: Article