Trends in Prevalence of Diabetes among Twin Pregnancies and Perinatal Outcomes in Catalonia between 2006 and 2015 : the DIAGESTCAT Study

The aims of our study were to evaluate the trends in the prevalence of diabetes among twin pregnancies in Catalonia, Spain between 2006 and 2015, to assess the influence of diabetes on perinatal outcomes of twin gestations and to ascertain the interaction between twin pregnancies and glycaemic status. A population-based study was conducted using the Spanish Minimum Basic Data Set. Cases of gestational diabetes mellitus (GDM) and pre-existing diabetes were identified using ICD-9-CM codes. Data from 743,762 singleton and 15,956 twin deliveries between 2006 and 2015 in Catalonia was analysed. Among twin pregnancies, 1088 (6.82%) were diagnosed with GDM and 83 (0.52%) had pre-existing diabetes. The prevalence of GDM among twin pregnancies increased from 6.01% in 2006 to 8.48% in 2015 (p < 0.001) and the prevalence of pre-existing diabetes remained stable (from 0.46% to 0.27%, p = 0.416). The risk of pre-eclampsia was higher in pre-existing diabetes (15.66%, p = 0.015) and GDM (11.39%, p < 0.001) than in normoglycaemic twin pregnancies (7.55%). Pre-existing diabetes increased the risk of prematurity (69.62% vs. 51.84%, p = 0.002) and large-for-gestational-age (LGA) infants (20.9% vs. 11.6%, p = 0.001) in twin gestations. An attenuating effect on several adverse perinatal outcomes was found between twin pregnancies and the presence of GDM and pre-existing diabetes. As a result, unlike in singleton pregnancies, diabetes did not increase the risk of all perinatal outcomes in twins and the effect of pre-existing diabetes on pre-eclampsia and LGA appeared to be attenuated. In conclusion, prevalence of GDM among twin pregnancies increased over the study period. Diabetes was associated with a higher risk of pre-eclampsia, prematurity and LGA in twin gestations. However, the impact of both, pre-existing diabetes and GDM, on twin pregnancy outcomes was attenuated when compared with its impact on singleton gestations

Documentación clínica, febrero 2017

Recurs d'aprenentatge de la Universitat Oberta de Catalunya. Material publicat amb llicència Creative Commons passats 6 semestres des de la data de publicació.Recurso de aprendizaje de la Universitat Oberta de Catalunya. Material publicado con licencia Creative Commons pasados 6 semestres desde la fecha de publicación.Learning material of the Universitat Oberta de Catalunya. Material published under a Creative Commons license after 6 semesters from the date of publication

Documentació sanitària, febrer 2014

Recurs d'aprenentatge de la Universitat Oberta de Catalunya.Recurso de aprendizaje de la "Universitat Oberta de Catalunya".Learning material of the "Universitat Oberta de Catalunya"

Documentació sanitària, febrer 2014

Recurs d'aprenentatge de la Universitat Oberta de Catalunya.Recurso de aprendizaje de la "Universitat Oberta de Catalunya".Learning material of the "Universitat Oberta de Catalunya"

Documentación clínica, febrero 2013

Recurs d'aprenentatge de la Universitat Oberta de Catalunya.Recurso de aprendizaje de la "Universitat Oberta de Catalunya".Learning material of the "Universitat Oberta de Catalunya"

Diseño, implantación y gestión de la información clínica y de un sistema de conocimiento sanitario, septiembre 2014

Recurs d'aprenentatge de la Universitat Oberta de Catalunya.Recurso de aprendizaje de la "Universitat Oberta de Catalunya".Learning material of the "Universitat Oberta de Catalunya"

Aplicació de les TIC a la pràctica mèdica dels serveis sanitaris, setembre 2011

Material docent de la Universitat Oberta de Catalunya.Material docente de la "Universitat Oberta de Catalunya".Learning material of the "Universitat Oberta de Catalunya"

Disseny, implantació i gestió de la informació clínica i d'un sistema de coneixement sanitari, setembre 2014

Recurs d'aprenentatge de la Universitat Oberta de Catalunya.Recurso de aprendizaje de la "Universitat Oberta de Catalunya".Learning material of the "Universitat Oberta de Catalunya"

Diseño, implantación y gestión de la información clínica y de un sistema de conocimiento sanitario, septiembre 2014

Recurs d'aprenentatge de la Universitat Oberta de Catalunya.Recurso de aprendizaje de la "Universitat Oberta de Catalunya".Learning material of the "Universitat Oberta de Catalunya"

Trends in prevalence of pre-existing diabetes and perinatal outcomes: a large, population-based study in Catalonia, Spain, 2006-2015

Introduction: This study aims to assess trends in the prevalence of pre-existing diabetes and whether the risk of adverse perinatal outcomes decreased in women between 2006 and 2015 in Catalonia, Spain. Research design and methods: A population-based study of 743 762 singleton deliveries between 2006 and 2015 in Catalonia, Spain, was conducted using data from the Spanish Minimum Basic Data Set. Cases of type 1 diabetes (T1DM) and 'type 2 diabetes and other pre-existing diabetes' ('T2DM and other PGD') were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Crude and age-adjusted annual prevalences were calculated. Poisson regression model was used to assess trends in prevalence and perinatal outcomes during the study period. Results: Overall prevalences of pre-existing diabetes, T1DM and 'T2DM and other PGD' were 0.52% (95% CI 0.51 to 0.54), 0.17% (95% CI 0.17 to 0.18) and 0.35% (95% CI 0.33 to 0.36), respectively. From 2006 to 2015, rates increased for pre-existing diabetes (from 0.43 (95% CI 0.39 to 0.48) to 0.56% (0.50 to 0.62), p<0.001), T1DM (from 0.14 (0.11 to 0.17) to 0.20% (0.17 to 0.23), p<0.001) and 'T2DM and other PGD' (from 0.29 (0.25 to 0.33) to 0.36% (0.31 to 0.40), p<0.001). Pre-eclampsia rose in women with pre-existing diabetes (from 4.38% to 8.97%, adjusted p<0.001), T1DM (from 3.85% to 12.88%, p=0.005) and 'T2DM and other PGD' (from 4.63% to 6.78%, adjusted p=0.01). Prevalence of prematurity, cesarean section and small for gestational age remained stable in all diabetes groups. However, the prevalence of macrosomia fell in women with pre-existing diabetes (from 18.18% to 11.9%, adjusted p=0.011) and 'T2DM and other PGD' (from 14.71% to 11.06%, non-adjusted p=0.022, adjusted p=0.305) and large for gestational age decreased in all diabetes groups (from 39.73% to 30.25% in pre-existing diabetes, adjusted p=0.004). Conclusions: The prevalence of pre-existing diabetes increased significantly in Catalonia between 2006 and 2015. Despite improvements in outcomes related to excessive birth weight, pre-eclampsia rates are rising and overall perinatal outcomes in women with pre-existing diabetes continue to be markedly worse than in the population without diabetes