https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(11)60614-4.pdf

Type 2 diabetes across generations: from pathophysiology to prevention and management

Objective To provide perinatal mortality and congenital anomaly rates for babies born to women with type 1 or type 2 diabetes in England, Wales, and Northern Ireland. Design National population based pregnancy cohort. Setting 231 maternity units in England, Wales, and Northern Ireland. Participants 2359 pregnancies to women with type 1 or type 2 diabetes who delivered between 1 March 2002 and 28 February 2003. Main outcome measures Stillbirth rates; perinatal and neonatal mortality; prevalence of congenital anomalies. Results Of 2359 women with diabetes, 652 had type 2 diabetes and 1707 had type 1 diabetes. Women with type 2 diabetes were more likely to come from a Black, Asian, or other ethnic minority group (type 2, 48.8%; type 1, 9.1%) and from a deprived area (type 2, 46.3% in most deprived fifth; type 1, 22.8%). Perinatal mortality in babies of women with diabetes was 31.8/1000 births. Perinatal mortality was comparable in babies of women with type 1 (31.7/1000 births) and type 2 diabetes (32.3/1000) and was nearly four times higher than that in the general maternity population. 141 major congenital anomalies were confirmed in 109 offspring. The prevalence of major congenital anomaly was 46/1000 births in women with diabetes (48/1000 births for type 1 diabetes; 43/1000 for type 2 diabetes), more than double that expected. This increase was driven by anomalies of the nervous system, notably neural tube defects (4.2-fold), and congenital heart disease (3.4-fold). Anomalies in 71/109 (65%) offspring were diagnosed antenatally. Congenital heart disease was diagnosed antenatally in 23/42 (54.8%) offspring; anomalies other than congenital heart disease were diagnosed antenatally in 48/67 (71.6%) offspring. Conclusion Perinatal mortality and prevalence of congenital anomalies are high in the babies of women with type 1 or type 2 diabetes. The rates do not seem to differ between the two types of diabetes.

https://www.bmj.com/content/bmj/333/7560/177.full.pdf

Perinatal mortality and congenital anomalies in babies of women with type 1 or type 2 diabetes in England, Wales, and Northern Ireland: population based study

Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Pregnancy

D uring the past 2 years, Clinical Diabetes has published “Diabetes Foundation,” an eight-part series intended to explain and review facets of diabetes care for general physicians and physicians in training. The goal of the series has been to improve diabetes care for patients treated by such physicians because only a very small percentage of patients with diabetes have access to an endocrinologist.

Although previous articles have focused on individual topics related to diabetes care and have reviewed available scientific data, this final article will focus on summarizing recommendations from the American Diabetes Association (ADA) and integrating them as a set of clinical practice guidelines. Information supporting the recommendations has appeared in the previous installments of “Diabetes Foundation” and from the ADA.1 Although there are always exceptions, it is likely that the majority of patients with diabetes or glucose abnormalities would benefit from implementation of many of these guidelines for prevention of diabetes itself and of the complications of diabetes and diabetes treatments.

Patients who are experiencing symptoms of diabetes such as polyuria, polydipsia, or unexplained weight loss should be screened for diabetes, especially if they are obese or overweight (BMI > 25 kg/m2). Asymptomatic adult patients should be tested at any age if they are overweight or obese and have an additional risk factor for diabetes. Children who are overweight (BMI greater than the 85th percentile or weight > 120% of ideal for height) should be screened for type 2 diabetes if they have a family history of type 2 diabetes, are of an ethnic background predisposed to diabetes, have signs of insulin resistance such as acanthosis nigricans on physical examination, have a maternal history of diabetes or gestational diabetes mellitus (GDM), or have other conditions typically associated with type 2 diabetes. Such testing in children should …

https://clinical.diabetesjournals.org/content/diaclin/29/4/163.full.pdf

Clinical Practice Recommendations

Aims/hypothesis
The aim of this study was to assess the risk of adverse perinatal outcomes in gestational diabetes mellitus (GDM) in a large national cohort.

/pdf/gestational-diabetes-and-adverse-perinatal-outcomes-from-716-3c22zpd4y4.pdf

Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012

Summary
Aims In many parts of the world the number of pregnancies in women with Type 2 diabetes mellitus (DM) now exceeds that in women with Type 1 DM, but there are few data published on perinatal mortality in Type 2 DM. This study reports observational data on perinatal mortality in Type 2 DM from a population with a high background rate of this disorder.

Methods Over a 12-year period (1985–1997) at the Diabetes Clinic at National Women’s Hospital, Auckland, there were 434 pregnancies in women with Type 2 DM (256 known and 178 diagnosed with gestational diabetes mellitus (GDM), but confirmed to have Type 2 DM early post-partum), 160 pregnancies in women with Type 1 DM and 932 in women with GDM. Perinatal mortality was classified as either intermediate fetal death (20–28 weeks’ gestation), late fetal death (28 weeks’ gestation to term) or early neonatal death (up to 1 month post-partum).

Results The perinatal mortality in Type 2 DM was 46.1/1000, significantly higher than the rates for the general population (12.5), Type 1 DM (12.5) and GDM (8.9) (P < 0.0001). Congenital malformations accounted for only 10% of the perinatal mortality. There was a seven-fold increase in the rate of late fetal death and 2.5-fold increase in the rates of intermediate fetal and late neonatal death. Subjects with Type 2 DM were significantly older and more obese than subjects with Type 1 DM, and presented later to the diabetes service.

Conclusions Perinatal mortality in Type 2 DM is significantly increased, mainly owing to an excess of late fetal death. Maternal factors such as obesity may be important contributors to the high perinatal mortality. Women diagnosed with GDM who have unrecognized Type 2 DM are also at high risk, but perinatal mortality is low in women with milder degrees of glucose intolerance in pregnancy.

Perinatal mortality in Type 2 diabetes mellitus.

Perinatal Mortality in Type 2 Diabetes Mellitus

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Perinatal mortality in Type 2 diabetes mellitus.

Perinatal Mortality in Type 2 Diabetes Mellitus