An audit of stillborn babies in mothers with diabetes mellitus at a tertiary South African Hospital

Abstract

Objectives and design: This study is a retrospective audit spanning six years following the implementation of a new guideline on the management of diabetes in pregnancy. It aims to describe the patient profile of pregnancies complicated by diabetes and stillbirth.

Setting: The study was performed in Tygerberg Hospital, Cape Town, a secondary and tertiary referral centre.

Subjects: Fifty-eight pregnancies were complicated by stillbirth (> 500 g).

Outcome measures: the patient profile, gestational age, co-morbidities, foetal/placental monitoring and avoidable factors were described.

Results: Many patients (32%) booked after 24 weeks’ gestation and missed appointments were common (26.2%). Stillbirths ascribed to diabetes constituted 2.3% of all stillbirths at the hospital during the study period. Of the stillbirths 28.1% had Type I diabetes mellitus (DM), 64.9% had Type II and 7.0% were in patients with gestational diabetes. The median HbA1c at delivery was 8.4% (range 6.0–14.1%). In the Type II group, 31 (77.5%) of the stillbirths occurred after 36 weeks, while those among the Type I cases ranged from 26 to 38 weeks.

Conclusion: Stillbirths amongst pregnant women with diabetes constituted a small percentage of the total stillbirth burden. Emphasising the importance of appropriate antenatal care to women with diabetes and increased surveillance from 36 weeks’ gestation may lower the number of stillbirths.

Keywords: diabetes mellitus, gestational diabetes, pregnancy, stillbirth