Background: The prevalence of Type 2 Diabetes Mellitus(T2DM) is increasing1. In regions with high rates such as Far North Queensland2, management of T2DM in pregnancy can pose significant challenges for obstetric services.
Aim: To compare obstetric and neonatal outcomes between women with Gestational Diabetes Mellitus(GDM) and T2DM over 12 months.
Methods: A retrospective audit of all women with diabetes in pregnancy, who delivered from July 2015 to June 2016 at Cairns Hospital(CH). Information was collected from “GDM Assist” database and from hospital electronic medical records.
Results: A total of 319 women were identified(14% of all deliveries at CH): 277 women (87%) had GDM, 38(12%) had T2DM and 4(1%) had T1DM. Women with T2DM were heavier than those with GDM(mean BMI 31.6 vs 28.9, P=0.039). Women with T2DM were more likely to be Indigenous(71% vs 36%, p<0.001) and have had more pregnancies(mean gravida 4 vs 3, p=0.016). Women with T2DM had very high rates of caesarean section(65% vs 41%, p=0.005). Mean age was similar(31.8 vs 33.18), and there was no difference in rates of smoking or alcohol use between groups. Women with T2DM were much more likely to require medication(95% vs 39%, p<0.001). Babies of mothers with T2DM had higher rates of shoulder dystocia(10% vs 1.8%, p=0.004) and lower APGARs at 1 minute(mean 7.86 vs 5.73, p=0.017), however, no difference in APGARs at 5 minutes. There was a trend towards more macrosomia in the T2DM group but this was not significant, as was admission to neonatal intensive care. There was no difference in rates of pre-term deliveries, assisted delivery or neonatal hypoglycaemia.
Conclusion: Women with T2DM continue to have worse obstetric and neonatal outcomes in comparison to those with GDM. Efforts need to be focused on this high risk group to prevent complications.