Association of types of diabetes and insulin dependency on birth outcomes

doi:10.12998/wjcc.v10.i7.2147

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World Journal of Clinical Cases

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World J Clin Cases. Mar 6, 2022; 10(7): 2147-2158
Published online Mar 6, 2022. doi: 10.12998/wjcc.v10.i7.2147

Association of types of diabetes and insulin dependency on birth outcomes

Pamela K Xaverius, Steven W Howard, Deborah Kiel, Jerry E Thurman, Ethan Wankum, Catherine Carter, Clairy Fang, Romi Carriere

Pamela K Xaverius, Deborah Kiel, Ethan Wankum, Department of Epidemiology and Biostatistics, Saint Louis University, St. Louis, MO 63104, United States

Steven W Howard, Department of Health Management and Policy, Saint Louis University, St. Louis, MO 63104, United States

Jerry E Thurman, Department of Endocrinology, Diabetes and Metabolism, SSM Health, St. Charles, MO 63303, United States

Catherine Carter, Division of Epidemiology, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI 53226, United States

Clairy Fang, Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA 90095, United States

Romi Carriere, Population Health Sciences Institute, Centre for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, England NE4 5PL, United Kingdom

Author contributions: Xaverius PK oversaw all aspects of this project including developing the research question, collecting and analyzing the data, and writing the overall manuscript; Xaverius PK and Kiel D designed the research study; Wankum E, Carter C, Fang C, and Carriere R analyzed the data; and Xaverius PK, Howard SW, and Thurman JE wrote the manuscript; All authors have read and approve the final manuscript.

Institutional review board statement: This study has been granted an exemption by the Institutional Review Board at Saint Louis University.

Conflict-of-interest statement: The authors have no financial or non-financial competing interests or conflicts of interests associated with this manuscript.

Data sharing statement: The data used in this manuscript were acquired from the Missouri Department of Health and Senior Services (MODHSS) and are not available for public access due to MODHSS guidelines. The contents of this document including data analysis, interpretation or conclusions are solely the responsibility of the authors and do not represent the official views of DHSS.

STROBE statement: The authors have read the STROBE Statement, and the manuscript was prepared and revised according to the STROBE Statement.

Corresponding author: Pamela K Xaverius, MA, PhD, Professor, Department of Epidemiology and Biostatistics, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63104, United States. pam.xaverius@slu.edu

Received: July 14, 2021
Peer-review started: July 14, 2021
First decision: August 8, 2021
Revised: September 21, 2021
Accepted: January 25, 2022
Article in press: January 25, 2022
Published online: March 6, 2022
Processing time: 230 Days and 11.7 Hours

Abstract

BACKGROUND

Diabetes rates among pregnant women in the United States have been increasing and are associated with adverse pregnancy outcomes.

AIM

To investigate differences in birth outcomes (preterm birth, macrosomia, and neonatal death) by diabetes status.

METHODS

Cross-sectional design, using linked Missouri birth and death certificates (singleton births only), 2010 to 2012 (n = 204057). Exposure was diabetes (non-diabetic, pre-pregnancy diabetes-insulin dependent (PD-I), pre-pregnancy diabetes-non-insulin dependent (PD-NI), gestational diabetes- insulin dependent (GD-I), and gestational diabetes-non-insulin dependent (GD-NI)]. Outcomes included preterm birth, macrosomia, and infant mortality. Confounders included demographic characteristics, adequacy of prenatal care, body mass index, smoking, hypertension, and previous preterm birth. Bivariate and multivariate logistic regression assessed differences in outcomes by diabetes status.

RESULTS

Women with PD-I, PD-NI, and GD-I remained at a significantly increased odds for preterm birth (aOR 2.87, aOR 1.77, and aOR 1.73, respectively) and having a very large baby [macrosomia] (aOR 3.01, aOR 2.12, and aOR 1.96, respectively); in reference to non-diabetic women. Women with GD-NI were at a significantly increased risk for macrosomia (aOR1.53), decreased risk for their baby to die before their first birthday (aOR 0.41) and no difference in risk for preterm birth in reference to non-diabetic women.

CONCLUSION

Diabetes is associated with the poor birth outcomes. Clinical management of diabetes during pregnancy and healthy lifestyle behaviors before pregnancy can reduce the risk for diabetes and poor birth outcomes.

Keywords: Epidemiology; Pregnancy; Health care delivery; Birth outcomes; Gestational diabetes; Insulin

Core Tip: This study investigated the differences in birth outcomes by timing of diabetes (pre-gestational and gestational) status and insulin use. The odds for preterm birth (PTB) and macrosomia were the most increased (187% and 201%, respectively) among women with insulin-dependent pre-pregnancy diabetes, followed by non-insulin dependent prepregnancy diabetes (77% and 112%, respectively) in comparison with women without diabetes. Women with insulin dependent gestational diabetes were also at an increased risk for PTB and macrosomia (73% and 95%, respectively). Clinical management of diabetes during pregnancy and healthy lifestyle behaviors before pregnancy can reduce the risk for diabetes and poor birth outcomes.