Maternal factors predictive of first‑trimester pregnancy loss in women with pregestational diabetes

INTRODUCTION Diabetes is one of the most frequent chronic diseases in women of childbearing age, which significantly increases the risk of complications at every stage of pregnancy. 
OBJECTIVES The aim of the study was to investigate any maternal factors that may be associated with the risk of first‑trimester pregnancy loss in patients with pregestational diabetes. 
PATIENTS AND METHODS It was a retrospective study based on the data of 91 diabetic women in singleton pregnancy and with good perinatal outcome (74 women [81.3%] with type 1 and 17 [18.7%] with type 2 diabetes), and 60 diabetic women with a miscarriage (48 women [80%] with type 1 and 12 [20%] with type 2 diabetes). We analyzed selected maternal parameters at the first admission to the obstetrics department. 
RESULTS Women in the miscarriage group were older compared with those in the good outcome group (29.5 ±5.4 years vs. 26.4 ±5.3 years; P <0.001). Hemoglobin A1c (HbA1c) was higher in the miscarriage group compared with the good outcome group (8.2% ±1.9% vs. 7.2% ±1.8%; P <0.001). In a stepwise logistic regression analysis, maternal age at booking and HbA1c were found to be significant predictors of miscarriage (odds ratio [OR], 1.10; 95% confidence interval [CI], 1.02–1.18 and OR, 1.28; 95% CI, 1.026–1.61; respectively). A statistically insignificant trend towards first-trimester pregnancy loss was observed in patients with hypertension, overweight/obesity, unplanned pregnancy, longer duration of diabetes, and diabetic vascular complications.  
CONCLUSIONS Suboptimal metabolic control and increasing maternal age are the most significant risk factors for first‑trimester miscarriage in women with pregestational diabetes.