Perinatal Outcomes in a Population of Diabetic and Obese Pregnant Women—The Results of the Polish National Survey
Abstract
:1. Introduction
1.1. Diabetes Mellitus—Overview
1.2. Diabetes Mellitus in Pregnancy—Classification
1.3. Obesity and Obesity in Pregnancy—Overview
1.4. Diabetes and Obesity during Pregnancy—Polish Guidelines and Standards
2. Materials and Methods
Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- American Diabetes Association. Introduction: Standards of Medical Care in Diabetes—2020. Diabetes Care 2019, 43, S1–S2. [Google Scholar] [CrossRef] [Green Version]
- Wender-Ozegowska, E.; Bomba-Opoń, D.; Brązert, J.; Celewicz, Z.; Czajkowski, K.; Gutaj, P.; Malinowska-Polubiec, A.; Zawiejska, A.; Wielgos, M. Standards of Polish Society of Gynecologists and Obstetricians in management of women with diabetes. Ginekol. Pol. 2018, 89, 341–350. [Google Scholar] [CrossRef] [Green Version]
- Araszkiewicz, A.; Bandurska-Stankiewicz, E.; Budzyński, A.; Cypryk, K.; Czech, A.; Czupryniak, L.; Drzewoski, J.; Dzida, G.; Dziedzic, T.; Franek, E.; et al. 2019 Guidelines on the management of diabetic patients. A position of Diabetes Poland. Clin. Diabetol. 2019, 8, 1–95. [Google Scholar] [CrossRef]
- World Health Organization (WHO). Global Report on Diabetes. Available online: https://www.who.int/diabetes/global-report/en/ (accessed on 20 October 2020).
- American Diabetes Association. Economic Costs of Diabetes in the U.S. in 2017. Diabetes Care 2018, 41, 917–928. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Negrato, C.A.; Mattar, R.; Gomes, M.B. Adverse pregnancy outcomes in women with diabetes. Diabetol. Metab. Syndr. 2012, 4, 41. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- World Health Organization (WHO). Diabetes Fact Sheet WHO. Available online: https://www.who.int/news-room/fact-sheets/detail/diabetes (accessed on 20 March 2020).
- International Association of Diabetes and Pregnancy Study Groups Consensus Panel. International Association of Diabetes and Pregnancy Study Groups Recommendations on the Diagnosis and Classification of Hyperglycemia in Pregnancy. Diabetes Care 2010, 33, 676–682. [Google Scholar] [CrossRef] [Green Version]
- American Diabetes Association. Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 2008, 32, S62–S67. [Google Scholar] [CrossRef] [Green Version]
- DeSisto, C.L.; Kim, S.Y.; Sharma, A.J. Prevalence Estimates of Gestational Diabetes Mellitus in the United States, Pregnancy Risk Assessment Monitoring System (PRAMS), 2007–2010. Prev. Chronic Dis. 2014, 11, E104. [Google Scholar] [CrossRef] [Green Version]
- Fong, A.; Serra, A.; Herrero, T.; Pan, D.; Ogunyemi, D. Pre-gestational versus gestational diabetes: A population based study on clinical and demographic differences. J. Diabetes Complicat. 2014, 28, 29–34. [Google Scholar] [CrossRef] [Green Version]
- Buchanan, T.A.; Xiang, A.H.; Page, K.A. Gestational diabetes mellitus: Risks and management during and after pregnancy. Nat. Rev. Endocrinol. 2012, 8, 639–649. [Google Scholar] [CrossRef] [Green Version]
- National Institute of Clinical Excellence (NICE). Diabetes in Pregnancy: Management of Diabetes and Its Complications from Preconception to the Postnatal Period. Available online: https://www.nice.org.uk/guidance/ng3 (accessed on 20 October 2020).
- Kim, C.; Newton, K.M.; Knopp, R.H. Gestational Diabetes and the Incidence of Type 2 Diabetes: A systematic review. Diabetes Care 2002, 25, 1862–1868. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Hruby, A.; Hu, F.B. The Epidemiology of Obesity: A Big Picture. PharmacoEconomics 2015, 33, 673–689. [Google Scholar] [CrossRef] [PubMed]
- Nuttall, F.Q. Body Mass Index. Nutr. Today 2015, 50, 117–128. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Pi-Sunyer, X. The Medical Risks of Obesity. Postgrad. Med. 2009, 121, 21–33. [Google Scholar] [CrossRef]
- The GBD 2015 Obesity Collaborators. Health effects of overweight and obesity in 195 countries over 25 years. N. Engl. J. Med. 2017, 377, 13–27. [Google Scholar] [CrossRef]
- Haslam, D.; James, W.P.T. Obesity. Lancet 2005, 366, 1197–1209. [Google Scholar] [CrossRef]
- Bleich, S.N.; Cutler, D.; Murray, C.; Adams, A. Why Is the Developed World Obese? Annu. Rev. Public Health 2008, 29, 273–295. [Google Scholar] [CrossRef] [Green Version]
- Nelson, S.M.; Matthews, P.; Poston, L. Maternal metabolism and obesity: Modifiable determinants of pregnancy outcome. Hum. Reprod. Update 2009, 16, 255–275. [Google Scholar] [CrossRef] [Green Version]
- Chen, C.; Xu, X.; Yan, Y. Estimated global overweight and obesity burden in pregnant women based on panel data model. PLoS ONE 2018, 13, e0202183. [Google Scholar] [CrossRef] [Green Version]
- Smith, G.C.; Shah, I.; Pell, J.P.; Crossley, J.A.; Dobbie, R. Maternal Obesity in Early Pregnancy and Risk of Spontaneous and Elective Preterm Deliveries: A Retrospective Cohort Study. Am. J. Public Health 2007, 97, 157–162. [Google Scholar] [CrossRef]
- Athukorala, C.; Rumbold, A.R.; Willson, K.; Crowther, C.A. The risk of adverse pregnancy outcomes in women who are overweight or obese. BMC Pregnancy Childbirth 2010, 10, 56. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Stothard, K.J.; Tennant, P.W.G.; Bell, R.; Rankin, J. Maternal Overweight and Obesity and the Risk of Congenital Anomalies. JAMA 2009, 301, 636–650. [Google Scholar] [CrossRef] [PubMed]
- Correa, A.; Marcinkevage, J. Prepregnancy obesity and the risk of birth defects: An update. Nutr. Rev. 2013, 71, S68–S77. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Kitzmiller, J.L.; Block, J.M.; Brown, F.M.; Catalano, P.M.; Conway, D.L.; Coustan, D.R.; Gunderson, E.P.; Herman, W.H.; Hoffman, L.D.; Inturrisi, M.; et al. Managing Preexisting Diabetes for Pregnancy: Summary of evidence and consensus recommendations for care. Diabetes Care 2008, 31, 1060–1079. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Polish Ministry of Health. Law Act. Rozporządzenie Ministra Zdrowia z Dnia 16 Sierpnia 2018 r. W Sprawie Standardu Organizacyjnego Opieki Okołoporodowej. Available online: http://prawo.sejm.gov.pl/isap.nsf/DocDetails.xsp?id=WDU20180001756 (accessed on 21 March 2020).
- Polish Ministry of Health. Law Act. Rozporządzenie Ministra Zdrowia z Dnia 20 Września 2012 r. W Sprawie Standardów Postępowania Medycznego Przy Udzielaniu Świadczeń Zdrowotnych z Zakresu Opieki Okołoporodowej Sprawowanej Nad Kobietą w Okresie Fizjologicznej Ciąży, Fizjologicznego Porodu, Połogu Oraz Opieki Nad Noworodkiem. Available online: http://prawo.sejm.gov.pl/isap.nsf/DocDetails.xsp?id=WDU20120001100 (accessed on 20 March 2020).
- Coustan, D.R.; Lowe, L.P.; Metzger, B.E.; Dyer, A.R. The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study: Paving the way for new diagnostic criteria for gestational diabetes mellitus. Am. J. Obstet. Gynecol. 2010, 202, 654.e1–654.e6. [Google Scholar] [CrossRef] [Green Version]
- Diabetes Poland. Polskie Towarzystwo Diabetologiczne—Zalecenia Kliniczne. Available online: https://cukrzyca.info.pl/zalecenia_kliniczne (accessed on 23 October 2020).
- Wender-Ozegowska, E.; Bomba-Opoń, D.; Brazert, J.; Celewicz, Z.; Czajkowski, K.; Karowicz-Bilińska, A.; Malinowska-Polubiec, A.; Meczekalski, B.; Zawiejska, A. Polish Gynecological Society standards of medical care in management of women with diabetes. Ginekol. Pol. 2011, 82, 474–479. [Google Scholar]
- Bomba-Opoń, B.B.; Celewicz, Z.; Czajkowski, K.; Karowicz-Bilińska, A.; Malinowska-Polubiec, A.; Męczekalski, B.; Zawiejska, A.; Wender-Ożegowska, W. Polish Gynecological Society standards of medical care in management of women with diabetes—Update. Ginekol. Pol. 2014, 85, 476–478. [Google Scholar]
- Wender-Ozegowska, E.; Bomba-Opoń, D.; Brazert, J.; Celewicz, Z.; Czajkowski, K.; Karowicz-Bilińska, A.; Malinowska-Polubiec, A.; Meczekalski, B.; Zawiejska, A. Recommendations of Polish Gynecological Society concerning perinatal care in obese pregnant women. Ginekol. Pol. 2012, 83, 795–799. [Google Scholar]
- Braveman, P.A. Social conditions, health equity, and human rights. Health Hum. Rights 2010, 12, 31–48. [Google Scholar]
- Wojtyła, C.; Wojtyła-Buciora, P. Polish Pregnancy-related Assessment Monitoring System (Pol-PrAMS): Research on lifestyle health behaviours of Polish women during gestation—Study design. J. Health Inequalities 2016, 2, 185–191. [Google Scholar] [CrossRef]
- Declercq, E.; Young, R.; Cabral, H.; Ecker, J. Is a Rising Cesarean Delivery Rate Inevitable? Trends in Industrialized Countries, 1987 to 2007. Birth 2011, 38, 99–104. [Google Scholar] [CrossRef] [PubMed]
- Ye, J.; Zhang, J.; Mikolajczyk, R.; Torloni, M.R.; Gülmezoglu, A.M.; Betran, A.P. Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: A worldwide population-based ecological study with longitudinal data. BJOG Int. J. Obstet. Gynaecol. 2016, 123, 745–753. [Google Scholar] [CrossRef] [PubMed]
- Ferrara, A. Increasing Prevalence of Gestational Diabetes Mellitus: A public health perspective. Diabetes Care 2007, 30, S141–S146. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Bell, R.; Bailey, K.; Cresswell, T.; Hawthorne, G.; Critchley, J.A.; Lewis-Barned, N. Trends in prevalence and outcomes of pregnancy in women with pre-existing type I and type II diabetes. BJOG Int. J. Obstet. Gynaecol. 2008, 115, 445–452. [Google Scholar] [CrossRef]
- Sheen, J.-J.; Wright, J.D.; Goffman, D.; Kern-Goldberger, A.; Booker, W.; Siddiq, Z.; D’Alton, M.E.; Friedman, A.M. Maternal age and risk for adverse outcomes. Am. J. Obstet. Gynecol. 2018, 219, 390.e1–390.e15. [Google Scholar] [CrossRef]
- Schmidt, L.; Sobotka, T.; Bentzen, J.G.; Andersen, A.N. Demographic and medical consequences of the postponement of parenthood. Hum. Reprod. Update 2011, 18, 29–43. [Google Scholar] [CrossRef] [Green Version]
- Bomba-Opoń, D.; Drews, K.; Huras, H.; Laudański, P.; Paszkowski, T.; Wielgos, M. Polish Gynecological Society Recommendations for Labor Induction. Ginekol. Pol. 2017, 88, 224–234. [Google Scholar] [CrossRef]
- Prenatal Screening Program of the Polish National Health Fund. Available online: https://www.pacjent.gov.pl/program-profilaktyczny/program-badan-prenatalnych (accessed on 13 May 2020).
- World Health Organization Human Reproduction Programme. WHO Statement on caesarean section rates. Reprod. Health Matters 2015, 23, 149–150. [Google Scholar] [CrossRef] [Green Version]
- Wielgos, M.; Bomba-Opoń, D.; Breborowicz, G.H.; Czajkowski, K.; Debski, R.; Leszczynska-Gorzelak, B.; Oszukowski, P.; Radowicki, S.; Zimmer, M. Recommendations of the Polish Society of Gynecologists and Obstetricians regarding caesarean sections. Ginekol. Pol. 2018, 89, 644–657. [Google Scholar] [CrossRef]
- Cutler, D.M.; Lleras-Muney, A. Education and Health: Evaluating Theories and Evidence; NBER Working Paper No. 12352; NBER: Cambridge, MA, USA, 2006. [Google Scholar]
- Amin, V.; Dunn, P.; Spector, T. Does education attenuate the genetic risk of obesity? Evidence from U.K. Twins. Econ. Hum. Biol. 2018, 31, 200–208. [Google Scholar] [CrossRef]
- Park, H.S.; Oh, S.W.; Park, H.S. Socioeconomic Status in Relation to Obesity and Abdominal Obesity in Korean Adults: A Focus on Sex Differences. Obesity 2006, 14, 909–919. [Google Scholar] [CrossRef]
- Vitner, D.; Harris, K.; Maxwell, C.; Farine, D. Obesity in pregnancy: A comparison of four national guidelines. J. Matern. Neonatal Med. 2018, 32, 2580–2590. [Google Scholar] [CrossRef] [PubMed]
- Institute of Medicine (US); National Research Council (US); Committee to Reexamine IOM Pregnancy Weight Guidelines. Weight Gain during Pregnancy: Reexamining the Guidelines; National Academies Press: Washington, DC, USA, 2009. [Google Scholar]
- Nasrat, H.; Fageeh, W.; Abalkhail, B.; Yamani, T.; Ardawi, M. Determinants of pregnancy outcome in patients with gestational diabetes. Int. J. Gynecol. Obstet. 1996, 53, 117–123. [Google Scholar] [CrossRef]
- Bo, S.; Menato, G.; Signorile, A.; Bardelli, C.; Lezo, A.; Gallo, M.; Gambino, R.; Cassader, M.; Massobrio, M.; Pagano, G. Obesity or diabetes: What is worse for the mother and for the baby? Diabetes Metab. 2003, 29, 175–178. [Google Scholar] [CrossRef]
- Pettersen-Dahl, A.; Murzakanova, G.; Sandvik, L.; Laine, K. Maternal body mass index as a predictor for delivery method. Acta Obstet. Gynecol. Scand. 2018, 97, 212–218. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Yen, I.-W.; Lee, C.-N.; Lin, M.-W.; Fan, K.-C.; Wei, J.-N.; Chen, K.-Y.; Chen, S.-C.; Tai, Y.-Y.; Kuo, C.-H.; Lin, C.-H.; et al. Overweight and obesity are associated with clustering of metabolic risk factors in early pregnancy and the risk of GDM. PLoS ONE 2019, 14, e0225978. [Google Scholar] [CrossRef]
- Egan, A.M.; Vellinga, A.; Harreiter, J.; Simmons, D.; Desoye, G.; Corcoy, R.; Adelantado, J.M.; Devlieger, R.; Van Assche, A.; Galjaard, S.; et al. Epidemiology of gestational diabetes mellitus according to IADPSG/WHO 2013 criteria among obese pregnant women in Europe. Diabetologia 2017, 60, 1913–1921. [Google Scholar] [CrossRef] [Green Version]
- Harreiter, J.; Desoye, G.; Van Poppel, M.; Kautzky-Willer, A.; Dunne, F.; Corcoy, R.; Devlieger, R.; Fracp, D.S.; Adelantado, J.M.; Damm, P.; et al. The Effects of Lifestyle and/or Vitamin D Supplementation Interventions on Pregnancy Outcomes: What Have We Learned from the DALI Studies? Curr. Diabetes Rep. 2019, 19, 162. [Google Scholar] [CrossRef]
Characteristics | 2012 | 2017 | p | |||
---|---|---|---|---|---|---|
N | % | N | % | |||
Age (years) | ns | |||||
≤25 | 543 | 19.2 | 656 | 19.2 | ||
26–30 | 974 | 34.5 | 1177 | 34.5 | ||
Over 30 | 1307 | 46.3 | 1580 | 46.3 | ||
Education | ns | |||||
Primary | 167 | 6.1 | 187 | 5.6 | ||
Secondary | 1240 | 45.1 | 1431 | 43.1 | ||
Tertiary | 1341 | 48.8 | 1704 | 51.3 | ||
Place of residence (inhabitants) | ns | |||||
City (≥100,000) | 725 | 25.8 | 804 | 24.1 | ||
Town/city (<100,000) | 977 | 34.8 | 1154 | 34.7 | ||
Rural area | 1103 | 39.3 | 1373 | 41.2 | ||
Social conditions | <0.05 | |||||
Very good | 735 | 26.0 | 1295 | 37.8 | ||
Good | 1610 | 57.0 | 1821 | 53.2 | ||
Average/poor | 478 | 16.9 | 308 | 9.0 | ||
Economic status | <0.05 | |||||
Very good | 284 | 10.1 | 652 | 18.9 | ||
Good | 1675 | 59.4 | 2188 | 63.4 | ||
Average/poor | 863 | 30.6 | 611 | 17.7 | ||
BMI before pregnancy (kg/m2) | <0.05 | |||||
<18.5 | 228 | 8.3 | 267 | 8.0 | ||
18.5–24.99 | 1907 | 69.5 | 2211 | 66.5 | ||
25.0–29.99 | 458 | 16.7 | 599 | 18.0 | ||
≥30 | 151 | 5.5 | 247 | 7.5 | ||
Parameter | N | Mean | S.D. | Minimum | Maximum | p |
Height (cm) | ns | |||||
2012 | 2752 | 166.0 | 6.1 | 139.0 | 188.0 | |
2017 | 3344 | 165.9 | 5.9 | 146.0 | 198.0 | |
Gestational weight gain (kg) | <0.05 | |||||
2012 | 2753 | 15.5 | 5.7 | 0.0 | 102.0 | |
2017 | 3307 | 14.7 | 6.2 | 0.0 | 89.0 |
Variable | 2012 | 2017 | p | ||
---|---|---|---|---|---|
N | % | N | % | ||
Diabetes (total number of patients) | 2799 | 100 | 3451 | 100 | |
No | 2672 | 95.5 | 3201 | 92.8 | <0.05 |
Yes | 127 | 4.5 (100.0) | 250 | 7.2 (100.0) | |
PGDM | 14 | 0.5 (11.0) | 36 | 1.0 (14.4) | |
GDM | 113 | 4.0 (89.0) | 214 | 6.2 (85.6) | |
Period when GDM was diagnosed | <0.05 | ||||
1st trimester | 4 | 3.5 | 29 | 13.6 | |
2nd or 3rd trimester | 109 | 96.5 | 185 | 86.4 | |
Obese (BMI ≥ 30 kg/m2) | <0.05 | ||||
No | 2592 | 94.5 | 3077 | 92.6 | |
Yes | 151 | 5.5 | 247 | 7.5 | |
Obese with GDM | <0.05 | ||||
No | 2795 | 99.7 | 3409 | 99.1 | |
Yes | 9 | 0.3 | 32 | 0.9 |
Variable | All Women | Obese Women * | Obese * with GDM | Diabetes ** | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
2012 N (%) | 2017 N (%) | p | 2012 N (%) | 2017 N (%) | p | 2012 N (%) | 2017 N (%) | p | 2012 N (%) | 2017 N (%) | p | |
Type of delivery | <0.05 | ns | ns | ns | ||||||||
Vaginal | 1706 (61.5) | 1879 (58.0) | 71 (48.0) | 109 (48.0) | 5 (55.6) | 11 (35.5) | 72 (58.5) | 134 (55.4) | ||||
C-section/assisted | 1070 (38.5) | 1360 (42.0) | 77 (52.0) | 118 (52.0) | 4 (44.4) | 20 (64.5) | 51 (41.5) | 108 (44.6) | ||||
Labor induction | <0.05 | ns | ns | ns | ||||||||
No | 2563 (90.8) | 3069 (88.9) | 136 (90.1) | 218 (88.3) | 7 (77.8) | 25 (78.1) | 112 (88.2) | 211 (84.4) | ||||
Yes | 261 (9.2) | 382 (11.1) | 15 (9.9) | 29 (11.7) | 2 (22.2) | 7 (21.9) | 15 (11.8) | 39 (15.6) | ||||
Fetal birth defects | ns | ns | - | ns | ||||||||
No | 2785 (98.6) | 2735 (98.5) | 146 (96.7) | 185 (98.9) | 9 (100.0) | 24 (100.0) | 127 (100.0) | 202 (99.0) | ||||
Yes | 39 (1.4) | 42 (1.5) | 5 (3.3) | 2 (1.1) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 2 (1.0) | ||||
Fetal birth-weight (g) | 3373 | 3368 | ns | 3565 | 3405 | <0.05 | 3603 | 3419 | ns | 3285 | 3342 | ns |
Standard deviation | 572 | 567 | 679 | 575 | 516 | 608 | 640 | 615 | ||||
Minimum | 380 | 300 | 1200 | 695 | 2900 | 1720 | 870 | 338 | ||||
Maximum | 5220 | 5470 | 5220 | 4870 | 4550 | 4850 | 4550 | 5000 |
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Wojtyla, C.; Stanirowski, P.; Gutaj, P.; Ciebiera, M.; Wojtyla, A. Perinatal Outcomes in a Population of Diabetic and Obese Pregnant Women—The Results of the Polish National Survey. Int. J. Environ. Res. Public Health 2021, 18, 560. https://doi.org/10.3390/ijerph18020560
Wojtyla C, Stanirowski P, Gutaj P, Ciebiera M, Wojtyla A. Perinatal Outcomes in a Population of Diabetic and Obese Pregnant Women—The Results of the Polish National Survey. International Journal of Environmental Research and Public Health. 2021; 18(2):560. https://doi.org/10.3390/ijerph18020560
Chicago/Turabian StyleWojtyla, Cezary, Pawel Stanirowski, Pawel Gutaj, Michal Ciebiera, and Andrzej Wojtyla. 2021. "Perinatal Outcomes in a Population of Diabetic and Obese Pregnant Women—The Results of the Polish National Survey" International Journal of Environmental Research and Public Health 18, no. 2: 560. https://doi.org/10.3390/ijerph18020560