Pregnancy outcomes in women with type 1 diabetes in China during 2004 - 2014: a retrospective study (the CARNATION Study).

BACKGROUND We aimed to report the pregnancy outcomes of women with type 1 diabetes (T1D) in China, on which data was sparse. METHODS This is a nationwide retrospective study conducted in 11 general medical centers in eight cities across China. We investigated the clinical data of all women who attended these centers with a singleton pregnancy and whose pregnancy ended between January 1st , 2004, and December 31st , 2014. Pregnancies of women with pregestational T1D were ascertained and compared with those of women without T1D. RESULTS From over 300,000 pregnancies over the 11-year study period, we identified 265 singleton pregnancies of women with T1D. One out of 265 (0.37%) maternal death was documented among women with T1D, and 83 out of 318,486 (0.03%) in those without T1D. Women with T1D suffered from higher rates of pregnancy loss(13.21% vs 2.92%, crude risk ratio [cRR] 5.08, 95% confidence interval [CI] 3.56-7.26) and pre-eclampsia(17.74% vs 4.20%, cRR 4.94, 95% CI 3.60-6.77) compared with those without T1D. Infants of these women with T1D had elevated rates of neonatal death(5.65% vs 0.16%, cRR 37.36, 95% CI 21.21-65.82) and congenital malformation(s)(8.26% vs 3.53%, cRR 2.46, 95% CI 1.54-3.93), compared with those of women without T1D. No significant improvement in pregnancy outcomes in women with T1D was observed over 2004-2014. CONCLUSION Pregnancy outcomes were persistently poor in women with T1D during 2004-2014 in China. Pregnancy care needs improving to reduce adverse pregnancy outcomes among Chinese women with T1D.