Cost-Benefit Analysis of Preconception Care for Women With Established Diabetes Mellitus

Elixhauser, Anne; Weschler, Joan M; Kitzmiller, John L.; Marks, James S.; Bennert, Harry W; Coustan, Donald R.; Gabbe, Steven G.; Herman, William H.; Kaufmann, Robert C.; Ogata, Edward S.; Sepe, Stephen J.

doi:10.2337/diacare.16.8.1146

Cited by 80 publications

(42 citation statements)

References 36 publications

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“…Extensive clinical studies have confirmed the need to start maternal metabolic treatment before or at the time of conception if the rate of fetal malformations is to be significantly reduced [1][2][3]. The absolute necessity for periconceptional care is now well accepted, however, the mechanism by which an early exposure to uncontrolled maternal diabetes could be carried-over to the organogenic phase remains to be elucidated [4].…”

Section: ]mentioning

confidence: 99%

In vitro study of the carry-over effect associated with early diabetic embryopathy in the rat

et al. 1994

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Summary Embryos were recovered from diabetic rats on day 5 of pregnancy and incubated in vitro for up to 72 h. Compared to control embryos, blastocysts from diabetic rats showed a marked impairment in growth that resulted at 48 h in a higher rate of degeneration and a lower morphological score in the developing population. After 72 h in vitro, fewer developing blastocysts from diabetic rats formed trophoblastic outgrowths and fewer of those implanted developed an inner cell mass when compared with the control group. When assessed for their cell content, blastocysts from diabetic rats contained fewer cells than control embryos at the start of the culture. This difference persisted, and even worsened, during the ensuing incubation period. The increasing cellular deficiency in blastocysts from diabetic rats was primarily located to their inner cell mass lineage but trophoblast growth was also affected. When trophoblast outgrowths were compared for their surface area and number of nuclei, those collected from diabetic rats were smaller, contained fewer nuclei and had a higher proportion of giant nuclei than control outgrowths. Our data thus demonstrate that despite their removal from the abnormal intra-uterine environment, blastocysts from diabetic rats remain functionally affected by their early exposure and fare less well than control embryos cultured under the same standard conditions. [Diabetologia (1994) 37: 855- 862]Key words Blastocyst, trophoblast outgrowth, inner cell mass, carry-over effect, rat.Extensive clinical studies have confirmed the need to start maternal metabolic treatment before or at the time of conception if the rate of fetal malformations is to be significantly reduced [1][2][3]. The absolute necessity for periconceptional care is now well accepted, however, the mechanism by which an early exposure to uncontrolled maternal diabetes could be carried-over to the organogenic phase remains to be elucidated [4]. Interesting data pertaining to this issue have been obtained in experiments showing that preimplantation embryos from either drug-treated or spontaneous diabetic mice have a decreased ability to develop in vitro when maintained under the same culture conditions as control embryos [5,6]. These observations were made at the morphological level, however, and it is not known whether such a discrepancy in growth potential extends to more subtle differences in the rate of embryonic cell proliferation and differentiation.In a previous study on the impact of the maternal diabetic condition on preimplantation growth in vivo, we demonstrated that blastocysts collected from diabetic rats contained fewer cells than control embryos [7] and that cells from the lineage responsible for forming the fetus were more affected in their proliferation than the cell population that gives rise to the placenta [8]. This deficiency in preimplantation development was corrected by treating the dia-

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Section: ]mentioning

confidence: 99%

In vitro study of the carry-over effect associated with early diabetic embryopathy in the rat

et al. 1994

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“…The risk of these outcomes may be minimized with preconceptional planning. Specifically, periconceptional folic acid supplementation and good glycemic control before pregnancy have been shown to reduce these risks to a level only slightly higher than that of the baseline population (2)(3)(4)(5)(6)(7)(8)(9)(10)(11).…”

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confidence: 99%

Health Literacy and Pregnancy Preparedness in Pregestational Diabetes

Sharp²,

et al. 2004

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OBJECTIVE -We investigated the association between functional health literacy and markers of pregnancy preparedness in women with pregestational diabetes.RESEARCH DESIGN AND METHODS -English-and Spanish-speaking pregnant women with pregestational diabetes were recruited. Women completed the Test of Functional Health Literacy in Adults (TOFHLA) short form and a questionnaire. A TOFHLA score of Յ30 was defined as low functional health literacy.RESULTS -Of 74 women participating in the study, 16 (22%) were classified as having low functional health literacy. Compared with women with adequate health literacy, those with low health literacy were significantly more likely to have an unplanned pregnancy (P ϭ 0.02) and significantly less likely to have either discussed pregnancy ahead of time with an endocrinologist or obstetrician (P ϭ 0.01) or taken folic acid (P ϭ 0.001).CONCLUSIONS -The results of this study suggest that low functional health literacy among women with pregestational diabetes is associated with several factors that may adversely impact birth outcomes. Diabetes Care 27:331-334, 2004A pproximately 19,000 pregnancies in the U.S. occur annually in women with pregestational diabetes. Although this represents a small proportion of total births, pregnancies in women with diabetes are important because of the potential for adverse outcomes, including spontaneous abortions, stillbirths, congenital anomalies, and the requirement for neonatal intensive care (1). The risk of these outcomes may be minimized with preconceptional planning. Specifically, periconceptional folic acid supplementation and good glycemic control before pregnancy have been shown to reduce these risks to a level only slightly higher than that of the baseline population (2-11).Many women with diabetes unfortunately fail to receive preconceptional counseling or to achieve good glucose control before pregnancy. Health care providers have attempted to determine the barriers to ideal diabetes care. Diabetes is a chronic disease that can be very confusing and frustrating for patients. Many patients may not understand their disease, the information their health care providers give them, or the importance of tight glucose control. Studies in nonpregnant diabetic subjects have confirmed the relationship between low socioeconomic status, low literacy, and poorer glycemic control with a higher risk of complications (12-15). Two studies (16,17) specifically evaluating functional health literacy in nonpregnant diabetic patients found very high rates of inadequate and marginal health literacy at 50 to 75%.Functional health literacy has not been studied in pregnant women with diabetes. We therefore performed a pilot study evaluating the association between low functional health literacy in women with pregestational diabetes and markers for adverse pregnancy outcome. RESEARCH DESIGN AND METHODS -Pregnant patients withpregestational diabetes, class B or higher, either type 1 or type 2, were prospectively recruited from three sites: two universitybased clini...

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“…Though delivering these services require huge amount of resources, the costs are nullified by the averted complications. 16,17 We have achieved a global consensus that preconception care is important as it addresses both maternal care and neonatal care.…”

Section: Preconception Care In Indiamentioning

confidence: 99%