Reference:
Syed M, Javed H, Yakoob MY, Bhutta ZA. Effect of screening and management of diabetes during pregnancy on stillbirths. BMC Public Health 2011; 11 (Suppl 3): S2. Background - Diabetes can increase the risk of stillbirth by five times, and the risk of neonatal death by three times (1).
- Studies have shown two to three times higher rates of perinatal mortality and also of congenital anomalies among babies of diabetic women as opposed to the general population (2, 3).
- Since the introduction of insulin as a treatment for diabetes, mortality and morbidity rates have improved; still, they remain significantly higher than those of the general population.
Intervention Effects Intensive Management of Gestational Diabetes (IMGD) during Pregnancy on Stillbirths - IMGD includes: specialized dietary advice, increased monitoring and tailored dietary therapy.
- Non-significant effect (RR: 0.20; 95% CI 0.03-1.10) on risk of stillbirths when compared to conventional management (dietary advice and insulin as required).
- 4 studies – moderate quality of evidence (insufficient number of events to recommend to LiST). Delphi process recommended.
Optimal Control of Serum Blood Glucose on Stillbirths and Perinatal Mortality - 60% significant reduction in the risk of perinatal mortality (RR: 0.40; 95% CI 0.25-0.63) - 2 studies.
- The effect was not significant for stillbirths (RR: 0.51; 95% CI 0.14-1.88) – 3 studies.
- Low quality of evidence, insufficient events for inclusion in LiST. Delphi process recommended.
Preconception Care of Pregestational Diabetes on Perinatal Mortality - Preconception care of diabetes includes: information about need for optimization of glycemic control before pregnancy, assessment of diabetes complications, review of dietary habits, intensification of capillary blood glucose self-monitoring and optimization of insulin therapy.
- 71% reduction in perinatal mortality (RR: 0.29; 95% CI 0.14-0.60) - 3 studies (moderate quality).
Optimal Diabetes Recognition and Management on Stillbirths - Due to low quality of evidence, a Delphi consensus process was utilized to estimate effect size.
- 10% reduction in antepartum stillbirths (IQR 5-30%).
- 10% reduction in intrapartum stillbirths (IQR 3.5-25%).
Intervention Recommendation - Very few studies of adequate quality are available that can provide estimates of the effect of screening for and management of diabetes in pregnancy on stillbirth risk. Therefore, a 10% reduction each in the risk of antepartum and intrapartum stillbirths (achieved from Delphi) is recommended for inclusion in LiST.
References from Syed Paper Cited Here - IInkster ME, Fahey TP, Donnan PT, Leese GP, Mires GJ, Murphy DJ. Poor glycated haemoglobin control and adverse pregnancy outcomes in type 1 and type 2 diabetes mellitus: systematic review of observational studies. BMC Pregnancy Childbirth 2006, 6:30.
- Casson IF, Clarke CA, Howard CV, McKendrick O, Pennycook S, Pharoah PO, et al. Outcome of pregnancy in insulin dependent diabetic women: results of a five year population cohort study. BMJ 1997, 315(7103): 275-8.
- Hawthorne G, Robson S, Ryall EA, Sen D, Roberts SH, Ward Platt MP. Prospective population based survey of outcome of pregnancy in diabetic women: results of the Northern Diabetic Pregnancy Audit, 1994. BMJ 1997, 315(7103):279-81.
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