Researchers in Norwich identified 158 first pregnancies in women with type 1 diabetes. They defined adverse pregnancy outcome as spontaneous abortion, major congenital malformation (potentially life threatening or associated with serious long term disability), stillbirth, or infant death.
The women were divided into two groups according to their level of blood glucose control - a group with fair control and a group with poor control.
Adverse outcome was over fourfold higher in the poor control group than the fair control group. Compared with the fair control group, the poor control group had a fourfold increase in spontaneous abortion, and a ninefold increase in major congenital malformation. Stillbirth or infant death was also higher in the poor control group, but the difference was not significant.
This study confirms earlier reports of increased risk of spontaneous abortion and malformation with poor glycaemic control in early pregnancy in women with type 1 diabetes, say the authors.
"Our findings suggest that good glycaemic control around the time of conception is necessary to optimise outcome of pregnancy in diabetic women. Diabetic women and their carers need to be advised of the risks and encouraged to optimise glycaemic control before and during pregnancy," they conclude.