Effectiveness of a regional prepregnancy care program in women with type 1 and type 2 diabetes: Benefits beyond glycemic control

Helen R. Murphy, Jonathan M. Roland, Timothy C. Skinner

Research output: Contribution to journalComment/debate

Abstract

A large number of studies have demonstrated that prepregnancy care for women with preconceptional diabetes improves glycemic control and reduces adverse pregnancy outcomes. However, only 2 regional centers, both nearly 20 years ago, have described the benefits of implementing prepregnancy care programs. A large study in the United Kingdom reported that relatively few maternity units provided prepregnancy care clinics for women with diabetes and that only 10% of diabetic women attended such clinics. In the absence of prepregnancy care, a majority of women with type 1 and 2 diabetes are at increased risk of potentially preventable poor pregnancy outcomes.
This prospective cohort study investigated the implementation and effectiveness of a regional prepregnancy care program on pregnancy preparation, glycemic control, and pregnancy outcomes in women with type 1 and type 2 diabetes at 10 regional maternity units. The study population comprised 680 pregnancies of women with type 1 and type 2 diabetes. Primary outcomes examined included adverse pregnancy outcome (miscarriage, congenital fetal malformation, stillbirth, neonatal death) and indicators of pregnancy preparation (folic acid supplementation, and glycemic control [HgbA1c]). A historical cohort of 613 pregnancies from the same units during 1999–2004 served as the control.
Overall, 27% (181/680) of the women with diabetes attended prepregnancy care and 73% did not. On comparison with the controls, women who attended prepregnancy care presented earlier (6.7 vs. 7.7 weeks; P < 0.0001), were more likely to use 5 mg preconception folic acid (88.2% vs. 26.7%; P < 0.0001), achieved lower HgbA1c levels (6.9% vs. 7.6%; P < 0.0001), and were less likely to conceive while on potentially harmful ACE inhibitors (1.1% vs. 4.6%; P < 0.05) and/or statins (0% vs. 7.6%; P< 0.0003). Overall, attendees had fewer adverse pregnancy outcomes (1.3% vs. 7.8%; P = 0.009). Multivariate logistic regression analysis showed that independent predictors of adverse outcome were glycemic control at booking (odds ratio, 1.46; 95% confidence interval, 1.16–1.85; P = 0.001 per 1% HgbA1c increase) and lack of prepregnancy care (odds ratio, 0.2; 95% confidence interval, 0.05–0.89; P = 0.03). Neither maternal age, parity, obesity, ethnicity nor socioeconomic deprivation was independent predictors of adverse outcome. Notable differences in pregnancy outcomes during 2006–2009 compared with 1999–2004 included an increase in folic acid supplementation (40.7% vs. 32.5%; P = 0.006) and fewer congenital malformations (4.3% vs. 7.3%; P = 0.04).
These findings show that implementation in routine care of a regional prepregnancy care program is associated with improved glycemic control and reduced risk of adverse pregnancy outcome in pregnancies of women with type 1 and type 2 diabetes.
Original languageEnglish
Pages (from-to)189-191
Number of pages3
JournalObstetrical and Gynecological Survey
Volume66
Issue number4
DOIs
Publication statusPublished - Apr 2011
Externally publishedYes

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