Background Women with pre-gestational diabetes experience an increased risk of adverse pregnancy outcome, but there are limited data on recurrence of adverse outcome. This study examined recurrence of adverse outcome in a cohort of women with pre-gestational diabetes from Northern England.
Methods 221 women with pre-gestational diabetes and with a first and second pregnancy during 1996–2008 were identified from the Northern Diabetes in Pregnancy Survey. Rates of adverse outcome (fetal loss at any gestation, major congenital anomaly, or infant death) for each pregnancy and recurrence rates were determined using descriptive approaches. Predictors of adverse outcome were examined by logistic regression.
Results 69 (31%) first pregnancies ended in adverse outcome, including 14 (6%) with congenital anomalies, 52 (24%) additional fetal losses and 3 (1%) additional infant deaths. 41 (19%) second pregnancies ended in adverse outcome, significantly less than the rate among first pregnancies (p=0.002), including 21 (10%) with congenital anomaly, 19 (9%) additional fetal losses, and 1 (<1%) additional infant death. 21 (10%) women experienced an adverse outcome in both pregnancies. Adverse outcome in the first pregnancy was associated with more than double the risk of an adverse outcome in the second pregnancy (RR=2.3 (95% CI 1.3 to 3.9)). Compared to those with no history of adverse outcome, women with recurrent adverse outcomes were more likely to be from an ethnic minority background (p=0.01).
Conclusion The overall risk of adverse pregnancy outcome is lower in second pregnancies than first, but history of an adverse outcome increases the risk in the second pregnancy.
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