Maternal diabetes during pregnancy – obstetrical considerations and long term effects

Abstract: Maternal diabetes mellitus (DM) during pregnancy has detrimental health impacts on both the mother and fetus, and include increased risks of cardiac malformations, cesarean section (CS), and asphyxia. The aim of the thesis was to investigate short and long term cardiac effects after fetal exposure to DM, investigate the ability of a 5 minute Apgar score as a marker for obstetrical care, investigate the association between mode of delivery in diabetic pregnancies and a low 5 minute Apgar score, and to investigate the association between offspring birth weight and maternal risk of future DM.
Paper 1: Fetuses to mothers with either type 1 DM (p = 0.0015) and gestational diabetes mellitus (GDM) (p = 0.006) showed increased pulsatility index in the ductus venosus (PI-DV) in relation to gestational age. After the exclusion of SGA fetuses and those with blood flow changes, the PI-DV was still increased in type 1 DM (p = 0.02) and GDM pregnancies (p = 0.035), presumably reflecting short term cardiac impact.
Paper 2: Fetuses exposed to type 1 DM showed an increased risk of future cardiovascular disease, as measured by consumption of drugs for cardiovascular disease, OR 1.46 (95% CI 1.16-1.83), this increased risk was however no longer present when data was adjusted for offspring with insulin dependent DM, OR 1.22 (95% CI 0.97-1.54). As previous studies have showed, an increased risk of future cardiovascular disease was found when born SGA, OR 1.29 (95% CI 1.24-1.35). No increased risk was found after being born LGA.
Paper 3: The Apgar score is a resourceful marker of obstetrical care, as a substantial risk increase of needing education in special schools, OR =1.93(95% CI 1.75-2.14) low, or no grades when graduating from compulsory school, in nearly all school subjects, was found after being born with a 5 minute Apgar score under 7. One of 44 children born with an Apgar-score <7 at 5 minutes after birth will need education in a special school due to the factors leading to the low Apgar score.
Paper 4: A 50% decreased risk of an Apgar score<7 at 5 minutes was found in DM+GDM pregnancies after a planned CS in gestational week 38 as compared to planned vaginal birth (from gestational week 39 and beyond), (p= 0.021), but no decreased risk was found in the DM group (p=0.08), GDM group (p=0.12) or LGA group alone (p=0.06).
Paper 5: Offspring birth weight is a direct mirror of the maternal metabolic status, as a profound risk increase of developing both type 1 OR=3.46 (95% CI 3.12-3.83) or type 2 DM OR= 2.90 (95% CI 2.80-3.01) was found subsequent to giving birth to a LGA or macrosomic fetus.