Managing blood sugar and weight in diabetic women may prevent stillbirth: Diabetologia

UK: Modifying maternal blood sugar and BMI may prevent stillbirths in women with diabetes, a recent study in the Diabetologia journal has found.

Diabetic mothers are at 4–5-fold increased risk of stillbirth. Fear of stillbirth has a major influence on obstetric management, particularly the timing of delivery. Sharon T. Mackin, University of Glasgow, Glasgow, UK, and colleagues analysed population-level data from Scotland to describe the timing of stillbirths in women with diabetes and associated risk factors.

The researchers analyzed f singleton deliveries to mothers with type 1 (n = 3778) and type 2 diabetes (n = 1614) from 1 April 1998 to 30 June 2016 using routine care data sets. They then compared maternal and fetal characteristics, HbA_1c data and delivery timing between stillborn and liveborn groups.

Key findings include:

• Stillbirth rates were 16.1 and 22.9 per 1000 births in women with type 1 (n = 61) and type 2 diabetes (n = 37), respectively.


• In women with type 1 diabetes, higher HbA_1c before pregnancy and in later pregnancy were associated with stillbirth, while in women with type 2 diabetes, higher maternal BMI and pre-pregnancy HbA_1c were associated with stillbirth.


• Risk was highest in infants with birthweights <10th centile (sixfold higher born to women with type 1 diabetes [n = 5 stillbirths, 67 live births]; threefold higher for women with type 2 diabetes [n = 4 stillbirths, 78 live births]) compared with those in the 10th–90th centile (n = 20 stillbirths, 1685 live births).


• The risk was twofold higher in infants with birthweights >95th centile born to women with type 2 diabetes (n = 15 stillbirths, 402 live births).


• A high proportion of stillborn infants were male among mothers with type 2 diabetes (81.1% vs 50.5% live births).


• A third of stillbirths occurred at term, with highest rates in the 38th week (7.0 per 1000 ongoing pregnancies) among mothers with type 1 diabetes and in the 39th week for type 2 diabetes.

"Maternal blood glucose levels and BMI are important modifiable risk factors for stillbirth in diabetes. Babies at extremes of weight centiles are at most risk. Many stillbirths occur at term and could potentially be prevented by a change in routine care and delivery policies," concluded the authors.

Factors associated with stillbirth in women with diabetes

DOI: https://doi.org/10.1007/s00125-019-4943-9