MedStar Researchers Study Pregnancy Outcomes for Women with Type 1 Diabetes

Pregnant woman standing outside in front of lake in fall

Tetsuya Kawakita, MD, and Elizabeth Coviello, DO, from the Department of Obstetrics and Gynecology at MedStar Washington Hospital Center, have collaborated on a study of the effect of type 1 diabetes mellitus on pregnancy outcomes in relation to prepregnancy weight as classified by body mass index (BMI).

Published in the American Journal of Perinatology, “Prepregnancy Weight in Women with Type I Diabetes Mellitus: Effect on Pregnancy Outcomes” was led by Dr. Kawakita. The analysis was conducted with data from the Diabetes in Pregnancy study at the University of Cincinnati (1978-1995).

The study cohort consisted of 426 women with type 1 diabetes who were recruited into the study prior to 20 weeks of gestation. The women were categorized by pre-pregnancy BMI based on self-reported weight prior to pregnancy or as documented in medical records. BMI was calculated as low (<20 kg/m2), normal (20 to <25 kg/m2), or high (>25 kg/m2). This secondary analysis examined participant outcomes, including spontaneous abortion, gestational hypertension, preeclampsia, abruptio placenta, emergent delivery for maternal indications, emergent delivery for fetal indications, and spontaneous preterm delivery.

Obesity is categorized as having a BMI >30 kg/m2.  Pregnancies carry additional risks for those who are obese, including gestational diabetes, preeclampsia, excessive fetal growth, and an increased risk for cesarean delivery. Type 1 diabetes mellitus also confers risks during pregnancy, including increased odds of fetal macrosomia, preterm delivery, preeclampsia, and primary cesarean delivery. No statistically significant differences were observed in maternal age, age at diagnosis of type 1 diabetes, marital status, or chronic hypertension across the BMI categories.

The results of this study showed that low maternal BMI was associated with preterm delivery. High BMI was associated with emergent delivery for maternal indications. “Lack of association between high prepregnancy BMI and preeclampsia in our study may be explained by the small number of women with a very high prepregnancy BMI; our population is over-weight rather than obese, with only 21 women with a BMI of 30 kg/m2 and above,” the study said.

American Journal of Perinatology, 2016. DOI: 10.1055/s-0036-1586506