Preconception care for diabetic women for improving maternal and infant health

Tieu, Joanna; Middleton, Philippa; Crowther, Caroline A; Shepherd, Emily

doi:10.1002/14651858.cd007776.pub3

Cited by 39 publications

(19 citation statements)

References 29 publications

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“…All reviews were published between 2007 and 2016 and included studies from high‐income countries and LMICs. Ten reviews focused specifically on preconception and/or interconception periods. Three reviews focused on interventions in different reproductive stages to prevent gestational diabetes, two focused on women with pre‐existing diabetes mellitus and one on women with overweight or obesity .…”

Section: Resultsmentioning

confidence: 99%

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Narrative review of reviews of preconception interventions to prevent an increased risk of obesity and non‐communicable diseases in children

2019

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Evidence for the effect of preconception and periconceptional risk factors on childhood outcomes such as obesity and other non-communicable diseases (NCDs) in later life is growing. Issues such as maternal malnutrition need to be addressed before pregnancy, to prevent a transgenerational passage of risk of NCDs. The aim of this review was to evidence for preconception interventions to prevent obesity and other risk factors for NCDs in children. A search for systematic reviews of interventions in the preconception period published between 2006 and 2018 was conducted on academic databases. Fifteen reviews were included, two of the reviews also included pregnant women. None of the reviews directly reported on obesity or NCD outcomes in children. Results suggest that exercise-and diet-based interventions significantly reduced maternal weight postpartum, weight gain during pregnancy, and improved prevention and control of gestational diabetes. Balanced protein energy supplementation during and before pregnancy was associated with an increase in mean birth weight and reduction of low birth weight babies. There is a dearth of evidence for preconception programmes that follow up on childhood outcomes related to a risk of NCDs. Nevertheless, results suggest that women who received preconception interventions were more likely to have improved pregnancy-related and behavioural outcomes.

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Section: Resultsmentioning

confidence: 99%

“…Three reviews considered outcomes related to GDM and two considered women with pre‐existing diabetes mellitus as their target population. A review of preconception care for diabetic women to improve both maternal and foetal outcomes included 20 studies (one controlled trial).…”

Section: Resultsmentioning

confidence: 99%

Narrative review of reviews of preconception interventions to prevent an increased risk of obesity and non‐communicable diseases in children

2019

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“…Preconception counseling has been associated with increased folic acid consumption, improved periconception glycemic control in diabetes, increase in immunization uptake, early entry into prenatal care, and increased rates of alcohol and smoking cessation. [13][14][15][16][17][18][19] Data on the effects of preconception health counseling or interventions on downstream pregnancy outcomes, however, remain limited. Promising findings include a meta-analysis indicating that preconception intervention in women with pregestational diabetes reduces the incidence of major and minor congenital anomalies 20 and a case-control analysis from a randomized trial suggesting that preconception folic acid intervention reduces the incidence of anomalies in women with epilepsy.…”

Section: Preconception Care Backgroundmentioning

confidence: 99%

Preconception Care in the Veterans Health Administration

et al. 2018

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Preconception care (PCC), defined as a set of interventions to help women optimize their health and well-being prior to pregnancy, can improve pregnancy outcomes and is recommended by national organizations including the Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists. Women Veterans who use the Department of Veterans Affairs (VA) health care system may face elevated risks of adverse pregnancy and birth outcomes due to a high prevalence of chronic medical and mental health conditions as well as psychosocial stressors including sexual trauma history and intimate partner violence. Many women Veterans of childbearing age experience poverty and homelessness, which are key social determinants of poor reproductive health outcomes. Furthermore, racial/ethnic disparities in maternal and neonatal outcomes are well documented, and nearly half of women Veterans of reproductive age are minority race/ethnicity. High-quality, equitable, patient-centered PCC services to address modifiable risks in this population are therefore a priority for VA. In this article, we provide a brief background of PCC, discuss the health risks of Veterans associated with adverse pregnancy outcomes, and highlight VA initiatives related to PCC. Lastly, we discuss implications and future directions for PCC research and policy within VA and across other health systems.

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“…Yet there are no high-quality randomized controlled trials (RCTs) assessing the effect of PCC on pregnancy outcomes. 29 The Atlantic Diabetes in Pregnancy (Atlantic-DIP) group identified poor outcomes and preparation for pregnancy in Irish women with preexisting diabetes and reevaluated outcomes after implementing a specialist-run PCC program. 30 They found improved attendance to PCC (28-52%), improved glycemic control (mean first pregnancy HbA 1c 7.3-6.9%), increased live births (74-92%), and decreased perinatal mortality (6.2-0.65%).…”

Section: Modifying Preconception Risk Factors To Prevent Adverse Outcmentioning

confidence: 99%

Type 1 and Type 2 Diabetes Preconception and in Pregnancy: Health Impacts, Influence of Obesity and Lifestyle, and Principles of Management

et al. 2016

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Preexisting diabetes in pregnancy results in increased risks to the mother, fetus, and neonate. Preconception care is vital to reduce risk of miscarriage, congenital malformations, and perinatal mortality. Preconception care should empower women with realistic goal setting, healthy lifestyle, and diabetes self-management skills, to ensure a positive experience of the pregnancy and to reduce diabetes-related distress. In high-risk women without known diabetes, preconception and early antenatal screening is crucial to enable prompt treatment of hyperglycemia and any complications. The prevalence of obesity in reproductive age women is rising, further increasing risk of poor pregnancy outcomes in women with diabetes. Adverse lifestyle factors should be addressed preconception and in the antenatal period, allowing opportunity to improve physical health, manage weight, and improve neonatal outcomes. Management of diabetes in pregnancy involves individualized and intensified insulin therapy, accounting for expected changes in insulin sensitivity, and minimizing glucose variability and hypoglycemia. Diabetes complications must be screened for and managed as necessary. Delivery timing will depend on fetal surveillance and obstetric considerations. It is important to maintain engagement and motivation of these women in the postpartum period, encouraging breastfeeding and postpartum weight management and supporting diabetes management.

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Preconception care for diabetic women for improving maternal and infant health

Abstract: Preconception care for diabetic women for improving maternal and infant health.

Cited by 39 publications

References 29 publications

Narrative review of reviews of preconception interventions to prevent an increased risk of obesity and non‐communicable diseases in children

Narrative review of reviews of preconception interventions to prevent an increased risk of obesity and non‐communicable diseases in children

Preconception Care in the Veterans Health Administration

Type 1 and Type 2 Diabetes Preconception and in Pregnancy: Health Impacts, Influence of Obesity and Lifestyle, and Principles of Management

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