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Objectives
To determine the pregnancy outcomes of a First Nations cohort of women with pre-existing
type 2 diabetes.
Methods
The Next Generation longitudinal study is a Canadian birth cohort of children born
to mothers of First Nations heritage with pre-gestational type 2 diabetes. A retrospective
review of the medical records for child-mother pairs born within this cohort (1995
and 2015) was performed. Maternal baseline characteristics, pregnancy and delivery
information, fetal ultrasound data, and fetal/newborn variables were collected and
analyzed descriptively.
Results
112 child-mother pairs born between 1995 and 2015 were identified. The median age
of mothers in the cohort was 22 and the median 1st trimester HbA1C was 9.3%. Most
mothers were overweight or obese at the start of pregnancy. With a median gestational
age at delivery of 37 weeks, the Cesarean section (CS) rate of this cohort was 41%
and over half of the newborns (55.5%) were macrosomic at birth. The rate of fetal
anomalies was 19.6%, with renal abnormalities being the most common (7.1%). The rate
of cardiac anomalies was 5.4% and 6% of fetuses had a single umbilical artery.
Conclusions
This cohort is the first of its kind to examine the impact of pre-gestational diabetes
on pregnancy longitudinally in a Canadian First Nations population. The high rates
of anomalies, macrosomia and CS provide valuable insights into disease processes in
pregnancy for First Nations women with diabetes and possible intrauterine origins
of health and disease in their offspring. There is also evidence of opportunity for
preconceptional optimization of maternal health.
Key Words
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Copyright
© 2019 Published by Elsevier Inc.
