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Pregestational diabetes mellitus during pregnancy and its adverse effects

Coton, Sonia Jayne; (2018) Pregestational diabetes mellitus during pregnancy and its adverse effects. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Abstract

Background: In 1989 the Saint Vincent declaration set out to reduce the risk for pregnant women with diabetes to those without diabetes. A number of studies, since the declaration found that foetal and neonatal adverse pregnancy outcomes in women with type 1 diabetes remained increased. Literature for women with type 2 diabetes and maternal complications is limited. My aim is to assess whether women with type 1 and 2 diabetes remain at increased risk of pregnancy complications. / Methods: Using a primary care database; THIN, I investigated the prevalence of: pregestational diabetes in pregnancy and pregnancy complications. Finally, I examined the risk of pregnancy complications for women with diabetes in pregnancy compared to women without diabetes in pregnancy. / Results: The prevalence of type 1 diabetes pregnancy increased from 1.58 to 4.34 per 1,000 pregnancies between 1995 and 2012. The prevalence of type 2 diabetes in pregnancy steadily increased from 2.38 to 4.83 per 1,000 pregnancies between 1995 and 2008; then increased more rapidly until the end of the study period to 10.37 per 1,000 pregnancies in 2012. Women with type 1 diabetes remained at increased risk of caesarean section (RR 2.41 (2.13, 2.72)) and major congenital malformations (RR 2.29 (1.53, 4.85)) compared to women without diabetes after adjusting for maternal characteristics. Women with type 2 diabetes remained at increased risk of caesarean section (RR 1.58 (1.42, 1.75) and perinatal death (RR 2.72 (1.53, 4.85)) when compared to women without diabetes after adjusting for maternal characteristics. / Conclusion: Women with type 1 and type 2 diabetes remained at increased risk of experiencing pregnancy complications. There is still substantial work to be done to reduce the adverse outcomes experienced by women with diabetes in pregnancy and meet the recommendations set out in the Saint Vincent declaration nearly thirty years ago.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: Pregestational diabetes mellitus during pregnancy and its adverse effects
Event: UCL (University College London)
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Copyright © The Author 2018. Original content in this thesis is licensed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) Licence (https://creativecommons.org/licenses/by/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health
URI: https://discovery.ucl.ac.uk/id/eprint/10061772
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