Obstetric and diabetic care for pregnancy in diabetic women: 10 years outcome analysis, 1985–1995

Hadden, David R.; Avian, Alexander; McCance, David R.; Traub, A

doi:10.1046/j.1464-5491.2001.00520.x

Cited by 30 publications

(17 citation statements)

References 20 publications

(20 reference statements)

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“…41,42 Consistently, women with T2DM in our study population were more obese and BMI at admission correlated positively with the rate of birth weight !4000 g. Taken together, these findings indicate that the impact of high maternal prepregnancy BMI might be greater than that of maternal hyperglycemia on infantile birth weight. 41,42 Pregnancy outcome in T1DM during 1995-2000 vs. 2001-2006 Consistent with studies from France 3,43 and Northern Ireland, 44 our data showed no improvement in the rate of congenital birth defects or perinatal death in T1DM women over time. However, the frequency of neonatal hypoglycemia within the first 24 hours after delivery and the rate of birth weight !4000 g decreased, although not statistically significantly.…”

Section: Pregnancy Outcome In T1dm Vs T2dm In 2001-2006supporting

confidence: 94%

Risk Factor Profile and Pregnancy Outcome in Women with Type 1 and Type 2 Diabetes Mellitus

Handisurya

Bancher‐Todesca

Schober

et al. 2011

Journal of Women's Health

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In addition to HbA1c, other risk factors, especially high BMI, strongly influence pregnancy outcome. The higher prevalence of these risk factors in T2DM might compensate for the better glycemic control, resulting in a pregnancy outcome comparable to that of T1DM. Pregnancy outcome in T1DM remained unchanged over time, possibly because of the missing amelioration of HbA1c levels and the increasing BMI.

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Section: Pregnancy Outcome In T1dm Vs T2dm In 2001-2006supporting

confidence: 94%

Risk Factor Profile and Pregnancy Outcome in Women with Type 1 and Type 2 Diabetes Mellitus

Handisurya

Bancher‐Todesca

Schober

et al. 2011

Journal of Women's Health

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“…This is the first attempt to systematically examine re gional pregnancy outcomes and use a novel mode of data collection (DIAMOND). Dia betic pregnancy outcomes have been re ported to be better in central compared with peripheral locations (2), and these findings have been confirm ed by this study, where perinatal mortality (still birth rate/perinatal mortality rate) and m orbidity (neonatal u n it adm issions, congenital malformation rate, infant size at birth) are more satisfactory at the cen tral com pared with the peripheral sites.…”

Section: Conclusion -The Atlanticsupporting

confidence: 53%

ATLANTIC DIP: Pregnancy outcome for women with pre-gestational diabetes along the Irish Atlantic seaboard.

et al. 2009

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FOR THE ATLANTIC DIP COLLABORATORSOBJECTIVE -Prospective evaluation of pregnancy outcomes in pregestational diabetes along the Atlantic seaboard 2006 -2007. RESEARCH DESIGN AND METHODS -The Atlantic Diabetes in Pregnancy group, representing five antenatal centers in a wide geographical location, was established in 2005. All women with diabetes for Ͼ6 months before the index pregnancy were included. Results were collected electronically via the DIAMOND Diabetes Information System. Pregnancy outcome was compared with background rates.RESULTS -There were 104 singleton pregnancies. The stillbirth rate (25/1,000) was 5 times, perinatal mortality rate (25/1,000) 3.5 times, and congenital malformation rate (24/1,000) 2 times that of the background population. A total of 28% of women received prepregnancy care, 43% received prepregnancy folic acid, and 51% achieved an A1C Յ7% at first antenatal visit.CONCLUSIONS -Women are not well prepared for pregnancy, and outcomes are suboptimal. A regional prepregnancy care program and centralized glucose management are urgently needed. Diabetes Care 32:1205-1206, 2009R obust information is lacking on pregnancy outcomes in women with diabetes in the Republic of Ireland. Along the Atlantic seaboard, there are five centers and 11,000 deliveries annually. A partnership occurred in 2005 with a focus on research, audit, clinical care, and professional and patient education (ATLANTIC DIP). This partnership is facilitating a number of projects, the results of which will shape future care. This report outlines the current position regarding pregnancy outcomes in women with established diabetes.RESEARCH DESIGN AND METHODS -The ATLANTIC DIP network established an electronic link between centers using DIAMOND (Hicom, Woking, U.K.), a diabetes clinical information system for data collection. DIAMOND is hosted at the central location as a secure service. Data captured in the peripheral clinics are consolidated in real time within the central DIAMOND database and made available in anonymized form for analysis and reporting.We studied women with established diabetes for Ͼ6 months before the index pregnancy in 2006 -2007. Women were managed according to local guidelines. Five values of A1C at the first visit; at 12, 24, and 36 weeks; and before delivery were chosen to represent the metabolic control. An ophthalmologist evaluated for retinopathy. Information regarding microalbuminuria (30 -300 mg/24 h), diabetic nephropathy (Ͼ300 mg/24 h), hypertension (pregestational treatment or a blood pressure Ͼ140/90 at first antenatal visit), pregnancyinduced hypertension (blood pressure Ͼ140/90 ϫ two measurements), preeclampsia (onset of blood pressure and proteinuria Ͼ300 mg/24 h after 20 weeks), preterm delivery Ͻ37 weeks gestation, large for gestational age (birth weight Ͼ4 kg), and small for gestational age (birth weight Ͻ2.5 kg) were recorded. Congenital malformations were those causing death or significant disability or those requiring surgical intervention. Perinatal mortality was defined as fetal ...

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“…These risks can be minimised by optimal glycaemic control, both prior to and throughout the pregnancy [15,16], and is best achieved through comprehensive preconception care where other issues such as genetic risks, health status, reproductive history, exposure to environment toxins, immunisation and lifestyle risk factors can also be addressed through a multidisciplinary approach in community based management of diabetes before and during pregnancy [17,18]. …”

Section: Introductionmentioning

confidence: 99%

Preconception care of women with diabetes: a review of current guideline recommendations

Mahmud

Mazza

2010

BMC Women's Health

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BackgroundThe prevalence of type 2 diabetes mellitus (T2DM) continues to rise worldwide. More women from developing countries who are in the reproductive age group have diabetes resulting in more pregnancies complicated by T2DM, and placing both mother and foetus at higher risk. Management of these risks is best achieved through comprehensive preconception care and glycaemic control, both prior to, and during pregnancy. The aim of this review was to compare the quality and content of current guidelines concerned with the preconception care of women with diabetes and to develop a summary of recommendations to assist in the management of diabetic women contemplating pregnancy.MethodsRelevant clinical guidelines were identified through a search of several databases (MEDLINE, SCOPUS and The Cochrane Library) and relevant websites. Five guidelines were identified. Each guideline was assessed for quality using the AGREE instrument. Guideline recommendations were extracted, compared and contrasted.ResultsAll guidelines were assessed as being of high quality and strongly recommended for use in practice. All were consistent in counselling about the risk of congenital malformation related to uncontrolled blood sugar preconceptionally, ensuring adequate contraception until glycaemic control is achieved, use of HBA1C to monitor metabolic control, when to commence insulin and switching from ACE inhibitors to other antihypertensives. Major differences were in the targets recommended for optimal metabolic control and opinion regarding the usage of metformin as an adjunct or alternative treatment before or during pregnancy.ConclusionsInternational guidelines for the care of women with diabetes who are contemplating pregnancy are consistent in their recommendations; however some are more comprehensive than others. Having established current standards for the preconception care of diabetic women, there is now a need to focus on guideline implementation through an examination of the barriers and enablers to successful implementation, and the applicability of the recommendations in the local setting.

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Obstetric and diabetic care for pregnancy in diabetic women: 10 years outcome analysis, 1985–1995

Cited by 30 publications

References 20 publications

Risk Factor Profile and Pregnancy Outcome in Women with Type 1 and Type 2 Diabetes Mellitus

Risk Factor Profile and Pregnancy Outcome in Women with Type 1 and Type 2 Diabetes Mellitus

ATLANTIC DIP: Pregnancy outcome for women with pre-gestational diabetes along the Irish Atlantic seaboard.

Preconception care of women with diabetes: a review of current guideline recommendations

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