GSB 7.1 Standardlösung

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Diabetes in Germany - adults

Stillbirth

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Both diabetes occurring for the first time during pregnancy (prevalence of gestational diabetes) and diabetes existing before pregnancy (pregestational diabetes) present a risk for complications during pregnancy and birth (DDG et al. 2021; DDG, DGGG 2018). The risk of stillbirth also increases in the presence of pregestational diabetes (DDG et al. 2021). However, a association between stillbirth and gestational diabetes has not been clearly proven (Ye et al, 2022; Lemieux et al. 2022).

Key messages

  • In 2021, the proportion of stillbirths to singletons was 0.39%.
  • The proportion of stillbirths is significantly higher in women with pregestational diabetes (1.1%) than in women without diabetes (0.39%); however, it is lower in women with gestational diabetes (0.25%).
  • Over time, the proportion of stillbirths is increasing, especially among women with pregestational diabetes (2013: 0.64%; 2021: 1.1%).

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Results

In 2021, the proportion of stillborn singletons was 0.39%. The proportion is lower in women with gestational diabetes (0.25%) and higher in women with pregestational diabetes (1.1%) than in women without diabetes (0.39%). Over time, the proportion of stillbirths increases in women without diabetes (2013: 0.32%; 2021: 0.39%), in women with gestational diabetes (2013: 0.23%; 2021: 0.25%), and in women with pregestational diabetes (2013: 0.64%; 2021: 1.1%).

Conclusion

Overall, stillbirth is relatively rare, but the proportion increases over time. Amon women with pregestational diabetes, the increase is particularly pronounced and is higher than reported by a previous analysis from Bavaria based on the same data (Beyerlein et al., 2018). Gestational diabetes, however, is associated with a lower proportion of stillbirth. This could be due to more intensive care for women with gestational diabetes, but also because women may not have received a test for gestational diabetes at the time of stillbirth (Hutcheon et al., 2013). The Federal Statistical Office also reports an increasing proportion of stillbirths over recent years (Destatis, 2022). Rising maternal age could explain only a modest portion of the increase. Thus, especially the care of women with pregestational diabetes should be focused on and the temporal development should be closely monitored further

Show more information on methodology and data sources

Definition

The indicator stillbirth is defined as the proportion of women with hospital births in a given year in which a stillbirth was documented.

Reference population

All women with inpatient singleton births in Germany.

Data sources

Quality assurance perinatal medicine (obstetrics) at the Institute for Quality and Transparency in Health Care (IQTIG) since 2015 based on the perinatal statistics provided by the federal states. This source provides data on all of the approximately 700,000 births that occur in German hospitals annually

Calculation

  • Observed relative values: Quotient of the number of women with documented stillbirth and the number of all women with hospital birth.
  • Age standardisation: Direct age standardization is performed using age groups <25, 25-29, 30-34, 35-39, and ≥40 years with the 2021 hospital birth population.
  • Stratification: The analysis distinguishes between women with pregestational diabetes (documented in Catalog A: "Medical History and General Findings/First Screening Examination" in the maternity log), gestational diabetes (prevalence of gestational diabetes), and no diabetes.

Data quality

The data only contains information on in-hospital birth, as the data is provided by the hospitals. Therefore, data from out-of-hospital births, which represent a very small proportion of less than 2%, are not included. As documentation of gestational diabetes in maternity logs might be incomplete, it is possible that prevalence is being underestimated. Furthermore, no distinction between type 1 and type 2 diabetes is possible in pregestational diabetes.

Referencen and external

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