Diabetes in pregnancy: are we providing the best care ... - HQIP

6. Factors associated with poor pregnancy outcome
in women with type 1 and type 2 diabetes
6.1 Introduction
Women with type 1 and type 2 diabetes continue to have an increased risk of adverse pregnancy
outcomes, including miscarriage, fetal congenital anomaly and perinatal death. 1-4 A case-control
approach was utilised within the enquiry module to examine the association of demographic and clinical
characteristics, social and lifestyle factors and clinical care with poor pregnancy outcome.
6.2 Methodology
Poor pregnancy outcome was defi ned as a singleton baby with a major congenital anomaly who delivered
at any gestation and/or a baby who died from 20 weeks gestation up to 28 days after delivery.
There were 222 cases that met the defi nition of poor pregnancy outcome. These comprised:
• Sixty one singleton babies with a major congenital anomaly who died at any gestation during
pregnancy and up to 28 days after delivery. This included terminations of pregnancy for fetal
congenital anomaly.
• Ninety fi ve singleton babies without a major congenital anomaly who died from 20 weeks gestation
up to 28 days after delivery.
• Sixty six babies with a major congenital anomaly who survived to 28 days after delivery.
There were 220 controls (singleton babies without a major congenital anomaly who survived to day
28 after delivery).
Odds ratios and associated 95% confi dence intervals were calculated to examine each factor identifi ed by
panels and its association with adverse outcomes. Odds ratios are also displayed adjusting for maternal
age and deprivation, where appropriate, to allow for the potential confounding by these factors.
6.2.1 Additional analyses
In addition to the primary analysis (section 6.2), associations of different factors with outcome were also
analysed using three separate case defi nitions:
• All major fetal congenital anomalies
• All deaths from 20 weeks gestation up to 28 days after delivery
• Deaths from 20 weeks gestation up to 28 days after delivery, excluding major fetal
congenital anomalies.
The results of these analyses can be found in Appendices C, D and E. In most cases the direction of
association was the same regardless of the case defi nition used. Any notable differences are highlighted
throughout the text.
6.3 Results
Associations of factors with poor pregnancy outcome are presented below. Each group of factors is
discussed in more detail in the relevant chapter in this report.
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