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Screening and Management of Diabetes during Pregnancy on Stillbirths

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More Intervention Effect Estimate Summaries

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

  1. 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.
  2. 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.
  3. 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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