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Diabetologia. 2017 Sep;60(9):1668-1677. doi: 10.1007/s00125-017-4314-3. Epub 2017 Jun 8.

Improved pregnancy outcomes in women with type 1 and type 2 diabetes but substantial clinic-to-clinic variations: a prospective nationwide study.

Author information

Norwich Medical School, Floor 2, Bob Champion Research and Education Building, University of East Anglia, Norwich, NR4 7UQ, UK.
Division of Women's Health, North Wing, St Thomas' Campus, Kings College London, London, UK.
Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
Clinical Audits & Registries Management Service, NHS Digital, Leeds, UK.
Department of Obstetrics, St Mary's Hospital, Central Manchester University Hospital NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
Department of Obstetrics, Singleton Hospital, Abertawe Bro Morgannwg, Swansea, UK.
Department of Diabetes and Endocrinology, Northumbria Healthcare NHS Foundation Trust, Northumberland, UK.



The aim of this prospective nationwide study was to examine antenatal pregnancy care and pregnancy outcomes in women with type 1 and type 2 diabetes, and to describe changes since 2002/2003.


This national population-based cohort included 3036 pregnant women with diabetes from 155 maternity clinics in England and Wales who delivered during 2015. The main outcome measures were maternal glycaemic control, preterm delivery (before 37 weeks), infant large for gestational age (LGA), and rates of congenital anomaly, stillbirth and neonatal death.


Of 3036 women, 1563 (51%) had type 1, 1386 (46%) had type 2 and 87 (3%) had other types of diabetes. The percentage of women achieving HbA1c < 6.5% (48 mmol/mol) in early pregnancy varied greatly between clinics (median [interquartile range] 14.3% [7.7-22.2] for type 1, 37.0% [27.3-46.2] for type 2). The number of infants born preterm (21.7% vs 39.7%) and LGA (23.9% vs 46.4%) were lower for women with type 2 compared with type 1 diabetes (both p < 0.001). The prevalence rates for congenital anomaly (46.2/1000 births for type 1, 34.6/1000 births for type 2) and neonatal death (8.1/1000 births for type 1, 11.4/1000 births for type 2) were unchanged since 2002/2003. Stillbirth rates are almost 2.5 times lower than in 2002/2003 (10.7 vs 25.8/1000 births for type 1, p = 0.0012; 10.5 vs 29.2/1000 births for type 2, p = 0.0091).


Stillbirth rates among women with type 1 and type 2 diabetes have decreased since 2002/2003. Rates of preterm delivery and LGA infants are lower in women with type 2 compared with type 1 diabetes. In women with type 1 diabetes, suboptimal glucose control and high rates of perinatal morbidity persist with substantial variations between clinics.


Further details of the data collection methodology, individual clinic data and the full audit reports for healthcare professionals and service users are available from .


Antenatal; Congenital anomaly; Diabetes; Glucose; Large for gestational age; Neonatal; Pre-pregnancy care; Pregnancy; Preterm; Stillbirth

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