Stillbirths more likely if diabetes in pregnancy not diagnosed

A UNIVERSITY of Huddersfield-based expert on midwifery has led a research project which found that pregnant women with undiagnosed and untreated diabetes can be up to four times more likely to have a stillborn child.

The finding bolsters official guidance that all women who are at a higher risk of gestational diabetes should receive blood screening for the condition.

Dr Tomasina Stacey is Reader in Midwifery Practice at the University of Huddersfield and the research project she led – while based at Leeds University – is described in a new article.  The study found that the risk of stillbirth was over four-times higher in women who developed signs of gestational diabetes but were not diagnosed.

However, with appropriate screening and diagnosis, the increased risk disappeared.

The National Institute for Care Excellence (NICE) recommends that all women at a higher risk of gestational diabetes should receive blood screening for the condition: this includes women with a raised body mass index (a BMI of over 30), or from South Asian or Black Caribbean ethnic groups.

Dr Stacey said: “The good news is that women with gestational diabetes have no increase in stillbirth risk if national guidelines are followed for screening, diagnosis and management.  The bad news is that the guidelines are not always followed and some women therefore experience avoidably higher risk.”

Funded by the charities Action Medical Research, Cure Kids, Sands and Tommy’s, the study compared the symptoms and care of 291 women who experienced a stillbirth to 733 similar women who did not experience a stillbirth across 41 maternity units in England.

Researchers found that across all women with high blood sugar, measured after a period of fasting, they had on average twice the risk of stillbirth than women without the condition.  The increased risk was likely to be caused by the missed diagnoses and lack of subsequent care.

Article co-author Professor Alexander Heazell, from the University of Manchester and Clinical Director of Tommy’s Stillbirth Research Centre, said: “It’s not clear why some women missed out on being screened or diagnosed for gestational diabetes, but this needs to be improved.

“Gestational diabetes can cause serious complications in pregnancy.  It’s important that we detect every woman with symptoms so she can receive the appropriate care and support.”

• The article, Gestational diabetes and the risk of late stillbirth: a case-control study from England, appears in BJOG: an International Journal of Obstetrics & Gynaecology.