OBSTETRIC AND PERINATAL OUTCOMES IN PREGNANT TYPE 2 DIABETIC PATIENTS

Background: In the last years, an increase in numbers of pregnant patients with type 2 diabetes mellitus (T2DM) has been observed. Nevertheless, obstetricians/gynecologists and endocrinologists are not sufficiently aware of this problem. 

Aim: To analyze specific features of pregnancy course and outcomes in female patients with T2DM. 

Materials and methods: We performed a retrospective and prospective analysis of specific characteristics of pregnancy course and outcomes in 70 females with T2DM who were seen from 2008 to 2013. These 70 patients delivered 72 babies (including two twins). 

Results: Seventeen (24.3%) patients in their past history had perinatal losses or disability of babies. 81.4% of patients were obese. Twenty seven (38.6%) patients had arterial hypertension. Thirty (41.3%) patients had good diabetes control pre-pregnancy, whereas others were sub-optimally or poorly controlled. At trimester I, 45 (64.3%) of patients were treated with oral hypoglycemic agents. Thirteen (18.6%) of patients were hydramniotic and 4 (5.7%) were olygoamniotic. Mild gestosis was observed in 12, moderate, in 10 and severe, in 2 patients. Preterm delivery was performed in 9 (12.9%) of patients, among them in 5 cases due to a critical state of the fetus. Natural deliveries occurred in 34 (48.6%) of females. Deliveries of big fetuses were observed in 10 (13.9%) of cases. Thirty four (47%) of newborns had diabetic fetopathy, 4 (5.5%) had birth trauma. The rate of congenital abnormalities was 9.7%. All patients whose babies had congenital abnormalities, had concepted while taking sensitizers, and 7 of them were poorly controlled by that time. Any unfavorable perinatal outcome was registered in 32%. 

Conclusion: Female patients with T2DM have a high frequency of unfavorable perinatal outcomes (birth defects, disability in babies, prolonged intensive care in the neonatal period), and among complications of pregnancy, a high rate of gestosis (in particular in patients with baseline arterial hypertension). Improvement of perinatal and obstetric outcomes would require an optimization of management of such patients. Thus, it is reasonable to establish a multi-disciplinary team of specialists, including obstetrician/gynecologists, endocrinologists, internists and neonatologists, on the bases of centers for perinatal care or multifield hospitals with big in-patient department of obstetrics.