Preconception care for diabetic women for improving maternal and fetal outcomes: a systematic review and meta-analysis

Abstract

BackgroundPreexisting diabetes mellitus is associated with increased risk for maternal and fetal adverse outcomes. Despite improvement in the access and quality of antenatal care recent population based studies demonstrating increased congenital abnormalities and perinatal mortality in diabetic mothers as compared to the background population. This systematic review was carried out to evaluate the effectiveness and safety of preconception care in improving maternal and fetal outcomes for women with preexisting diabetes mellitus.MethodsWe searched the following databases, MEDLINE, EMBASE, WEB OF SCIENCE, Cochrane Library, including the CENTRAL register of controlled trials and CINHAL up to December 2009, without language restriction, for any preconception care aiming at health promotion, glycemic control and screening and treatment of diabetes complications in women of reproductive age group with type I or type II diabetes. Study design were trials (randomized and non-randomized), cohort and case-control studies. Of the 1612 title scanned 44 full papers were retrieved of those 24 were included in this review. Twelve cohort studies at low and medium risk of bias, with 2502 women, were included in the meta-analysis.ResultsMeta-analysis suggested that preconception care is effective in reducing congenital malformation, RR 0.25 (95% CI 0.15-0.42), NNT17 (95% CI 14-24), preterm delivery, RR 0.70 (95% CI 0.55-0.90), NNT = 8 (95% CI 5-23) and perinatal mortality RR 0.35 (95% CI 0.15-0.82), NNT = 32 (95% CI 19-109). Preconception care lowers HbA1c in the first trimester of pregnancy by an average of 2.43% (95% CI 2.27-2.58). Women who received preconception care booked earlier for antenatal care by an average of 1.32 weeks (95% CI 1.23-1.40).ConclusionPreconception care is effective in reducing diabetes related congenital malformations, preterm delivery and maternal hyperglycemia in the first trimester of pregnancy.

Preconception care for women with type 2 diabetes mellitus: A mixed-methods study of provider knowledge and practice

“…Preconception care, specifically with the aim of optimising glycaemic control, can reduce these adverse outcomes [4][5][6][7]. This care needs to incorporate contraception and pregnancy planning whilst optimising a woman's health to improve pregnancy outcomes.…”

The interconnections between maternal and newborn health – evidence and implications for policy

“…Optimal glycemic control during pregnancy may reduce these diabetes-related risks, but a more effective time to intervene could be before pregnancy. A number of systematic reviews on the effectiveness of preconception care in diabetic women show positive trends in maternal and newborn health outcomes [86,91,92].…”

Effect of implementation of a preconception counselling resource for women with diabetes: A population based study

“…Planning pregnancy with the emphasis on optimizing glycemic control before conception reduces the risk of adverse outcomes [6][7][8][9][10]. All women with diabetes of childbearing potential should be counselled as to the risks associated with pregnancy and diabetes and of the benefits of planning for pregnancy.…”