Maternal and neonatal outcomes in patients with type 1 diabetes mellitus in pregnancy in a South African cohort

Background. Women with type 1 diabetes mellitus (T1DM) are at high risk of maternal, pregnancy and neonatal complications. Limited data on this topic are available in Africa. Objective. To describe characteristics of patients in South Africa with T1DM in pregnancy, and associated outcomes. Methods. Clinical and biochemical data were collected on 273 women with T1DM: maternal clinical characteristics, glycated haemoglobin (HbA1c) and maternal and neonatal complications and outcomes. Results. There was a statistically significant decline in HbA1c from first presentation to delivery (8.7% (standard deviation (SD) 2.2) v. 6.4% (SD 2.4)), respectively; p<0.00001). The perinatal mortality rate was 7.2%. In this cohort, 31.9% of patients experienced hypoglycaemia. Patients with hypoglycaemia had a significantly longer duration of diabetes, and higher HbA1C than those without hypoglycaemia (7.5 (SD 5.7) v. 6.1 (SD 4.5) years, p=0.002; 9.0% (SD 1.9) v. 8.5% (SD 2.3), p=0.04, respectively)). Conclusion. This cohort showed a high perinatal mortality rate and a high prevalence of hypoglycaemia and caesarean section. Intensification in glycaemic control is important to improve outcomes, but comes with challenges. A significant HbA1C reduction can be achieved with regular follow-up and management with a multidisciplinary team. Despite poor baseline glycaemic control, the prevalence of congenital abnormalities and macrosomia was low.