Objective: To study childbirth and the risk of miscarriage and infertility among women who have received a diagnosis of type 2 diabetes before the start of their reproductive journey.

Design: Register-based cohort study using the Skane Healthcare Register.

Setting: All healthcare visits for the whole population of the southernmost region in Sweden over the past 20 years.

Patient(s): All women who were aged 18-45 years between January 1, 1998 and December 31, 2019 and who received a clinical diagnosis of type 2 diabetes before their first childbirth, miscarriage, or infertility diagnosis (n = 230) were compared with a healthcareseeking population of women without any type of diabetes, matched for calendar year and age (n = 179,434).

Intervention(s): None.

Main Outcome Measure(s): Childbirth, miscarriage, and infertility diagnosis.

Result(s): The birthrate was lower among women with type 2 diabetes (62.6% vs. 83.8%), and they were less likely to give birth (crude risk ratio [RR] = 0.73, 95% confidence interval [CI]: 0.66-0.81). They had a higher risk of experiencing a miscarriage (RR = 1.88, 95% CI: 1.50-2.36). The risk of infertility was increased (RR = 3.44, 95% CI: 2.88-4.10) as was the risk of having infertility and not giving birth (RR = 4.47, 95% CI: 3.44-5.82). All results remained the same after adjustment for polycystic ovary syndrome and obesity.

Conclusion(s): Women with type 2 diabetes with onset before their reproductive journey were more often childless compared with women without diabetes and had a higher risk of experiencing both miscarriage and infertility. This patient group may be in need of targeted information regarding potential fertility issues as part of their clinical treatment. ((c) 2021 by American Society for Reproductive Medicine.) El resumen esta disponible en Espanol al final del articulo.