Differing Causes of Pregnancy Loss in Type 1 and Type 2 Diabetes

Differing Causes of Pregnancy Loss in Type 1 and Type 2 Diabetes Tim Cundy , MD 1 2 , Greg Gamble , MSC 1 , Leonie Neale , RM 2 , Rose Elder , FRACOG 2 , Paul McPherson , FRACOG 2 , Patrick Henley , FRACP 2 and Janet Rowan , FRACP 2 1 Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand 2 Diabetes Pregnancy Service, National Women's Health, Auckland City Hospital, Auckland, New Zealand Address correspondence and reprint requests to Dr. Tim Cundy, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand. E-mail: t.cundy{at}auckland.ac.nz Abstract OBJECTIVE —Women with type 2 and type 1 diabetes have differing risk factors for pregnancy loss. We compared the rates and causes of pregnancy loss in women with type 1 and type 2 diabetes. RESEARCH DESIGN AND METHODS —We utilized prospectively collected data on all pregnancies in a 20-year period (1986–2005) from a single center with a high prevalence of type 2 diabetes. Pregnancy losses included terminations for medical reasons and deaths up to 1 month postpartum but not spontaneous pregnancy losses 75% were attributable to major congenital anomalies or prematurity; in type 2 diabetes >75% were attributable to stillbirth or chorioamnionitis ( P = 0.017). Women with type 2 and type 1 diabetes had similar A1C at presentation and near term, but the former were older ( P < 0.001) and more obese ( P < 0.0001). CONCLUSIONS —There are significant differences in the main causes of pregnancy loss in women with type 1 and type 2 diabetes. The higher rates of stillbirth in women with type 2 diabetes, suggest that other features, such as obesity, contribute significantly to pregnancy losses. Footnotes Published ahead of print at http://care.diabetesjournals.org on 22 June 2007. DOI: 10.2337/dc07-0555. A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances. The costs of publication of this article were defrayed in part by the payment of