Pregnancy Outcomes May Be Worse for Asian Diabetes

NEW YORK (Reuters Health) - A UK study shows that while diabetes has an impact on pregnancy, the outcomes are significantly worse in women from the Indian subcontinent with pre-existing diabetes compared with those with pregnancy onset, or "gestational" diabetes.

"This suggests pre-conceptual care in particular needs to identify and target this group and that they need high-quality care," senior investigator Dr. Derek J. Tuffnell, told Reuters Health.

Dr. Tuffnell and Dr. Evelyn C. J. Verheijen of Bradford Royal Infirmary and colleagues note that much research on pregnancy outcomes has focused on type 1 diabetes, but it appears that type 2 diabetes may also have adverse effects.

To investigate, the researchers studied data for 202 pregnancies in 166 women with pre-existing diabetes. In 101 pregnancies, the diabetes was type 1, or "juvenile" diabetes, and in the remainder it was type 2, or "adult-onset" diabetes.

All women with type 1 diabetes took insulin before pregnancy, as did 28 of the type 2 diabetics, the team reports in the British Journal of Obstetrics and Gynaecology.

Sixty of the women who were studied were Caucasian while most of the others were of Asian origin, with the majority coming from Pakistan.

In total, 13 of the 14 stillbirths were in Pakistani women and the remaining stillbirth was in an Indian mother. In addition, 13 of 15 congenital abnormalities were seen in Asian women, most of whom were Pakistani.

In Asian women with type 2 diabetes, congenital abnormalities were about 10-times more common in those who used insulin prior to pregnancy.

Overall, after accounting for other risk factors, the risk of fetal or infant death and malformation was almost five-times more common Asian women compared with Caucasian women.

The researchers conclude that ethnicity has a significant impact on the outcome of such pregnancies. Moreover, added Tuffnel, "type 2 diabetes requiring insulin has the same poor outcome as type 1 when corrected for ethnicity, suggesting that all women with pre-existing diabetes need the same level of supervision of their care in pregnancy."

SOURCE: British Journal of Obstetrics and Gynaecology, November 2005.