Cardiometabolic Risk Factors and Adverse Outcomes in Pregnant Women with Type 2 Diabetes

Context The prevalence of type 2 diabetes (T2DM) in pregnancy is increasing rapidly worldwide. Consequently, there is a need to gain more knowledge about pregnant women with T2DM. Objective The current study aimed to assess the prevalence of cardiometabolic risk factors and co-morbidities in women with T2DM before and during pregnancy, and to evaluate associations with adverse obstetric and perinatal outcomes. A comparison between women with pre-existing T2DM (P-T2DM) and women with T2DM first recognized during pregnancy (N-T2DM) was also performed. Design A retrospective Danish national population-based cohort study, including all pregnancies in women with T2DM, giving birth to a live infant after 24 weeks of gestation, from 2004 until 2019. Results The population included 1297 pregnancies in women with T2DM (1207 P-T2DM, 90 N-T2DM). Before pregnancy, 20.4 % smoked, 13.4 % had chronic hypertension, 12.5 % had dyslipidemia, and 63.1 % had obesity. Only 58.6 % of women with P-T2DM entered pregnancy with hemoglobin A1c (HbA1c) < 53 mmol/mol (7.0 %). During pregnancy, 73.4 % had an excessive weight gain, and 21.6 % attained a median HbA1c < 38 mmol/mol (5.6 %). Preeclampsia was observed in 9.1 % of women, preterm delivery in 19.0 %, and large-for-gestational-age birthweight in 32.2 % of infants. Obstetric and perinatal outcomes were similar in women with P-T2DM and N-T2DM. All modifiable exposures were associated with one or more severe adverse outcomes. Conclusions Cardiometabolic risk factors are prevalent in pregnant women with T2DM and are associated with severe adverse outcomes for mother and child.