Poster Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2017

RATIONALE

Cairns Hospital has approximately 2400 deliveries per year and over the last 10 years had 169 recorded cases of stillbirth. Compared with the national average of 5-6%, 14% of pregnancies in Cairns Hospital are complicated by diabetes; 12% gestational diabetes mellitus (GDM), 2% type 2 diabetes (T2DM), and <1% type 1 diabetes (T1DM).

AIM

To identify risk factors associated with intrauterine death or stillbirth in mothers with diabetes in pregnancy.

METHODS

Retrospective audit of all mothers admitted to Cairns Hospital with an intrauterine death or still birth >20 weeks gestation, and either GDM, T1DM or T2DM between April 2006 and April 2016.

FINDINGS

We identified 15 cases to 13 different mothers, representing 9% of total cases of intrauterine death or still birth. Eight women (62%) had T2DM, 2 (15%) had T1DM and 3 (23%) had GDM. All of the women with T2DM were Aboriginal or Torres Strait Islander, 63% lived remotely, and 50% attended recommended clinic appointments. A large number (88%) had proteinuria. All of the women with T1DM or GDM were non-indigenous. Of the 10 mothers who had T1DM or T2DM, 8 (80%) had HbA1c >7%. In the total group, 6 of 13 mothers (46%) smoked during their pregnancy, 4 (30%) consumed alcohol, and 9 (69%) had BMI >25. Only 4 of the 13 (31%) had an abnormal ultrasound but 6 (46%) had had a previous pregnancy loss. Of note, 3 of the 8 (37.5%) mothers with T2DM died within the study period.

DISCUSSION

Indigenous women with T2DM and proteinuria are highly over-represented in this audit. Of concern is the risk of repeated pregnancy loss and the fact that over one third of these young women died within the 10 year period. Practitioners need to be aware of this high risk population.