Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2022; 10(7): 2147-2158
Published online Mar 6, 2022. doi: 10.12998/wjcc.v10.i7.2147
Association of types of diabetes and insulin dependency on birth outcomes
Pamela K Xaverius, Steven W Howard, Deborah Kiel, Jerry E Thurman, Ethan Wankum, Catherine Carter, Clairy Fang, Romi Carriere
Pamela K Xaverius, Deborah Kiel, Ethan Wankum, Department of Epidemiology and Biostatistics, Saint Louis University, St. Louis, MO 63104, United States
Steven W Howard, Department of Health Management and Policy, Saint Louis University, St. Louis, MO 63104, United States
Jerry E Thurman, Department of Endocrinology, Diabetes and Metabolism, SSM Health, St. Charles, MO 63303, United States
Catherine Carter, Division of Epidemiology, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI 53226, United States
Clairy Fang, Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA 90095, United States
Romi Carriere, Population Health Sciences Institute, Centre for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, England NE4 5PL, United Kingdom
Author contributions: Xaverius PK oversaw all aspects of this project including developing the research question, collecting and analyzing the data, and writing the overall manuscript; Xaverius PK and Kiel D designed the research study; Wankum E, Carter C, Fang C, and Carriere R analyzed the data; and Xaverius PK, Howard SW, and Thurman JE wrote the manuscript; All authors have read and approve the final manuscript.
Institutional review board statement: This study has been granted an exemption by the Institutional Review Board at Saint Louis University.
Conflict-of-interest statement: The authors have no financial or non-financial competing interests or conflicts of interests associated with this manuscript.
Data sharing statement: The data used in this manuscript were acquired from the Missouri Department of Health and Senior Services (MODHSS) and are not available for public access due to MODHSS guidelines. The contents of this document including data analysis, interpretation or conclusions are solely the responsibility of the authors and do not represent the official views of DHSS.
STROBE statement: The authors have read the STROBE Statement, and the manuscript was prepared and revised according to the STROBE Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Pamela K Xaverius, MA, PhD, Professor, Department of Epidemiology and Biostatistics, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63104, United States. pam.xaverius@slu.edu
Received: July 14, 2021
Peer-review started: July 14, 2021
First decision: August 8, 2021
Revised: September 21, 2021
Accepted: January 25, 2022
Article in press: January 25, 2022
Published online: March 6, 2022
ARTICLE HIGHLIGHTS
Research background

Diabetes mellitus (DM) rates in the United States have been increasing and women with diabetes in pregnancy have high rates of congenital anomalies, preeclampsia, preterm delivery, macrosomia, and perinatal mortality. In the United States, approximately seven percent of pregnancies are affected by DM, a condition in which a woman’s blood glucose levels are above normal. The effect of insulin resistance on birth outcomes has been well documented. There is an important gap in the published literature, however, regarding population level studies of diabetes during pregnancy. For example, several large cohort studies of birth certificate data have reported an association between diabetes and birth outcomes, although differences in birth outcomes between diabetes types have rarely been reported.

Research motivation

Understanding the differential impact of prepregnancy diabetes with and without insulin dependence and GDM can offer important clues to understanding the population impact of insulin dependence on birth outcomes in the United States. This study explores how birth outcomes vary for women exposed based upon timing of diabetes (pre-gestational or gestational) and insulin-dependence, building upon previous studies by including potentially important confounders like BMI (a reliable measure for population-based surveillance).

Research objectives

To investigate differences in birth outcomes (preterm birth, macrosomia, and infant mortality/) by diabetes status.

Research methods

Cross-sectional design, using linked Missouri birth and death certificates [singleton births only), 2010 to 2012 (n = 204057). Exposure was diabetes (non-diabetic, pre-pregnancy diabetes-insulin dependent (PD-I), pre-pregnancy diabetes-non-insulin dependent (PD-NI), gestational diabetes- insulin dependent (GD-I), and gestational diabetes-non-insulin dependent (GD-NI)]. Outcomes included preterm birth, macrosomia, and neonatal death. Confounders included demographic characteristics, adequacy of prenatal care, BMI, smoking, hypertension, and previous preterm birth. Bivariate and multivariate logistic regression assessed differences in outcomes by diabetes status.

Research results

Women with PD-I, PD-NI, and GD-I remained at a significantly increased odds for preterm birth (aOR 2.87; aOR 1.77; and aOR 1.73, respectively) and having a very large baby (macrosomia) (aOR 3.01, aOR 2.12; aOR and 1.96;, respectively); in reference to non-diabetic women. Women with GD-NI were at a significantly increased risk for macrosomia (aOR1.53), decreased risk for their baby to die before their first birthday (aOR 0.41) and no difference in risk for preterm birth in reference to non-diabetic women.

Research conclusions

As categories of diabetes differed, so too did risk for poor birth outcomes, with having insulin use among women with pre-pregnancy diabetes putting women at the highest risk for the poorest birth outcomes.

Research perspectives

Diabetes is associated with the poor birth outcomes. Clinical management of diabetes during pregnancy and healthy lifestyle behaviors before pregnancy can reduce the risk for diabetes and poor birth outcomes.