engleski

Perinatal mortality and congenital malformations in offspring of pregestational diabetic mothers in Croatia

Background. Pregnant vvomen vvith type 1 and type 2 diabetes mellitus are associated vvith an increased risk of congenital malformations, perinatal mortality, obstetric complications, and neonatal morbidity. Methods. We analyzed perinatal outcomes and the incidence of congenital malformations in offspring of type 1 and type 2 diabetic mothers from 1993 until 2008 years divided in the two periods. The aim of the study vvas to examine the cases of type 1 and type 2 diabetic mothers during the tvvo periods 1993. - 2000 (the first period) and 2001- 2008 (the second period) recorded by EUROCAT of Congenital Malformations. Results. In the first period there were 228 births after vvhere the mother had type 1 diabetes and 12 births vvhere the mother had type- 2 diabetes. In the second period there were 277 births after a pregnancy vvhere the mother had type 1 diabetes and 69 births vvhere the mother had type-2 diabetes. In the second period there were statistically significant higher number of deliveries by type 2 diabetic mothers (p<o.ooi). Perinatal mortality in the second period vvas statistically significant lovver than in the second period (1.2%: 4.6% ; p<o.os). Incidence of congenital malformations did not different betvveen two periods (5% : 6.4% ; n.s.). Thirty- four (5.8%) malformations were identified. In the group of type 1 diabetic mothers there vvere 28 (5.54%) malformations, and in the group of type 2 diabetic mothers there vvere 6 (7.4%) malformed cases. Perinatal mortality in the group of malformed cases vvas 17.4% (6 cases ; 2 stillbirths and 4 neonatal mortality). The types of malformations identified vvere: cardiovascular (17) ; musculoskeletal (4) ; urinary (7) ; CNS (2) ; gastrointestinal (3) ; multiple malformation (1). Significantly higher rate of obesity (BMI 22.713.4:25.9+4.6 ; p<0.05) and older maternal age (28.613.5:31.914.5 ; p<o.o5) vvas observed in diabetic mothers of malformed cases. The incidence of congenital malformations are related to periconceptional care, especiallythe level ofglycemiccontrol (HbAic 7.211.8:9.8+1.6 ; pco.ooi). Conclusion: In the second research period in offspring of pregestational diabetic mothers perinatal mortality significantly decreased. Adequate preconceptional care reduces the frequency of congenital malformations and improves outcome of pregnancy.

perinatal mortality; congenital malformations; offspring; diabetes; Croatia

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