Pregnancy losses in women with type 1 or type 2 diabetes in the UK: an investigation using primary care records

Aim: This study aims to investigate pregnancy losses in women with type 1 and type 2 diabetes and compare this with the general population.

Methods: Pregnancies ending between 1993 and 2006 in those with type 1 or type 2 diabetes were identified on the General Practice Research Database. Pregnancy losses were identified from medical records and the cohort described by their characteristics and prescribing for diabetes.

Results: Of 2001 pregnancies identified in women with type 1 diabetes, 678 ended in a pregnancy loss: 19.6% were spontaneous, 9.6% were induced and 4.3% were losses for unknown reasons. In women with type 2 diabetes there were 240 losses in 669 pregnancies: 21.1% were spontaneous, 10.3% induced and 4.0% were losses for unknown reasons. The proportion of spontaneous losses in women with diabetes was higher than in the general population (13.2%). Women with type 1 diabetes treated with human and analogue insulins were 60% more likely to have a delivery than a loss (OR=1.6 CI95 1.18-2.18) compared with human insulin treatment alone although numbers were small.

Conclusion
We found that the proportions of spontaneous losses in women with type 1 and type 2 diabetes were similar at approximately 20% which is higher than in the general population and also higher than previous studies have reported. While much emphasis has been placed on pre-conception care for women with type 1 diabetes, the same is now needed for those with type 2 diabetes, given the similarity in outcomes and increasing prevalence of this condition.