Publication, Part of National Pregnancy in Diabetes Audit
National Pregnancy in Diabetes Audit 2021 and 2022 (01 January 2021 to 31 December 2022)
Audit
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3 June 2024 00:00 AM
Population Demographics
Women with early-onset type 2 diabetes now make up 56% of pregnancies in people with diabetes, with pregnancies in this group continuing to increase year-on-year. The interaction between living in a deprived area and pregnancy in women with type 2 diabetes is striking, with only 6.5% of these pregnancies among women from the least deprived areas (6.5% quintile 1, 36.5% quintile 5). A socio-economic gradient was also apparent among type 1 diabetes pregnancies (15.7% quintile 1, 24.1% quintile 5).
The proportion of women from ethnic minorities differs markedly between type 1 and early-onset type 2 diabetes (9.9% type 1, 52.6% type 2 diabetes). Women with early-onset type 2 diabetes are also older when giving birth (median 30 years type 1, 35 years type 2), and have higher BMI (median 26.3 kg/m2 type 1, 33.1 kg/m2 type 2), meaning that 90% of women with early-onset type 2 diabetes were already overweight or obese at the start of pregnancy. The median duration of diabetes was longer in type 1 diabetes (15 years) and notably shorter in early-onset type 2 diabetes (3 years), meaning that many women with early-onset type 2 may benefit from referral to NHS diabetes remission and weight management programmes.
Women with early-onset type 2 diabetes have lower HbA1c at pregnancy entry (36.0% type 2 vs 23.7% type 1 achieving NICE target HbA1c <48mol/mol) and also after 24 weeks gestation (55.3% type 2 vs 31.2% type 1 achieving pregnancy target HbA1c <43mmol/mol). However, during the same time periods (2021 and 2022, 2019 and 2020, 2014 to 2018), the notable improvements in target HbA1c attainment during 2021 and 2022 are confined to type 1 diabetes pregnancies (31.2%, 21.4%, 23.2%), with no change in those with type 2 diabetes (55.3%, 54% 54.5%). This means that there has been no improvement in maternal glucose among women with early-onset type 2 diabetes over the past 9 years. Importantly, the improvements in maternal glucose were accompanied with a reduction in diabetic ketoacidosis events in women with type 1 diabetes (1.6% 2021, 2.8% 2020, 2.9% 2014 to 2018). Furthermore, they were achieved without additional severe hypoglycaemia (12.1% 2021, 13.2% 2019 and 2020, 11.9% 2014 to 2018).
Preterm birth rates were rising in type 1 diabetes peaking at 47.1% in 2019 and 2020 before falling to 41.4% in 2021 and 2022. By contrast, preterm birth rates in type 2 diabetes are unchanged over 9 years (24.3% 2021 and 2022, 23.0% 2019 and 2020, 23.3% 2014 to 2018). Likewise, the percentage of large for gestational age babies (customised birth weight >90th percentile) had been increasing in type 1 diabetes pregnancies, peaking at 54.5% in 2019 and 2020 before decreasing to 48.9% in 2021 and 2022. This is attributed to more babies in the appropriate for gestational age category (46.1% 2021 and 2022, 40.6% 2019 and 2020), and was achieved without increases in the proportion of small for gestational age babies with birthweight <10th percentile (5.0% 2021 and 2022). Related to their earlier gestational age at birth (median 37 +1 type 1, 37 +5 weeks type 2), and higher rates of large for gestational age babies, mothers with type 1 diabetes were more likely to be delivered by caesarean section (70.9% type 1, 62.6% type 2).
Whilst mothers with type 2 diabetes have fewer large for gestational age babies the proportion of large for gestational age babies is unchanged in the past 9 years (23.8% 2021 and 2022, 25.3% 2019 and 2020, and 25.1% previously). Mothers with type 2 diabetes have more small for gestational age babies (16.1% 2021 and 2022, 15.1% 2019 and 2020, 15.4% previously) also unchanged over the past 9 years.
In keeping with the reduction in preterm births and large birthweight babies, there was also a reduction in the proportion of babies of mothers with type 1 diabetes admitted to neonatal care units (46.2% 2021 and 2022, 55.4% 2019 and 2020, 53.5% 2014 to 2018). The rates of neonatal care unit admission were unchanged for babies of mothers with type 2 diabetes (31.5% 2021 and 2022, 32.7% 2019 and 2020, 34.4% 2014 to 2018).
Last edited: 3 June 2024 10:35 am