Short communication: The relationship between pre‐pregnancy care and early pregnancy loss, major congenital anomaly or perinatal death in type I diabetes mellitus

Abstract

The relationships between markers of pregnancy planning and prepregnancy care and adverse outcomes (early pregnancy loss, major congenital anomaly and perinatal death) were examined in 423 singleton pregnancies in women with pre-gestational type I diabetes mellitus. Pregnancy planning and markers of prepregnancy care were associated with reduced risks of adverse pregnancy outcomes. 'Documentation of achievement of an optimal haemoglobin A1c prior to discontinuation of contraception' was the marker associated with the lowest rate of adverse outcome (OR 0.2; 95% CI 0.06-0.67) and might serve as an appropriate definition of pre-pregnancy care for research and audit purposes.Keywords Anomaly, pre-pregnancy, type 1 diabetes.Please cite this paper as: Pearson D, Kernaghan D, Lee R, Penney G on behalf of the Scottish Diabetes in Pregnancy Study Group. The relationship between pre-pregnancy care and early pregnancy loss, major congenital anomaly or perinatal death in type I diabetes mellitus. BJOG 2007;114:104-107. IntroductionDiabetes is the most common pre-existing medical condition in pregnancy, and although there are international and national guidelines for management, 1 outcomes remain significantly worse than for the nondiabetic population. 2-4 Some adverse outcomes, such as miscarriage and major congenital anomaly, are related to glycaemic control before and during early pregnancy. 4 At present, there is no standardised definition of pre-pregnancy care that is agreed by clinicians and research teams. A recent report from the Confidential Enquiries into Maternal and Child Health (CEMACH) described a preconception care service for women with diabetes as 'a multidisciplinary service which aims to provide information about diabetes and pregnancy, assess for and treat diabetes complications, review drug medication and work together with women to achieve optimal glycaemic control before pregnancy'. Such care would include a range of interventions such as reviewing and optimising blood glucose control, initiating folic acid and treating related medical conditions. In this study, we describe relationships between various markers of pregnancy planning and pre-pregnancy care in the context of type I diabetes. We suggest a definition of prepregnancy care for research and audit, which could be extended to type II diabetes, where outcomes are equally unfavourable. 3 MethodsThe publication of national guidelines for diabetic pregnancy in Scotland (SIGN 9 and SIGN 55) prompted national audits of pregnancy management and outcomes. During two national audit periods, 5 information was collected on all pregnancies in Scotland in women with pre-gestational type I diabetes mellitus. Women were registered at antenatal booking or at the first contact during pregnancy with a healthcare professional. A proforma was completed at the end of each pregnancy by a local carer by detailed case note review. In addition to the collection of information about outcomes, the proforma was designed to clarify the extent of pregnancy planning and the ...

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

“…The DVD resource is women centred, featuring eight women with diabetes sharing their views and experiences, alongside an evidence-based commentary. The DVD has 3 parts: Part 1, "things you need to know", encompassing sections entitled 'contraception', 7 'risks, 'why plan' and a 'pre-pregnancy checklist'; Part 2 "things you might not know" encompassing sections entitled 'support team', 'blood glucose targets, hypos and ketoacidosis' and 'diet'; and Part 3 "Things you may want to know!!" encompassing sections entitled '1 st 2 nd and 3 rd trimester', 'Delivery' and 'Post-birth'.…”

“…Women with diabetes preceding pregnancy are at significant risk of adverse pregnancy outcomes when compared to the general maternity population, with higher rates of miscarriage, congenital malformations and stillbirth [1][2][3][4][5][6][7]. Planning pregnancy with the emphasis on optimizing glycemic control before conception reduces the risk of adverse outcomes [6][7][8][9][10].…”

“…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.…”

Prognóstico obstétrico de pacientes portadoras de diabetes mellitus pré-gestacional

“…Vários estudos apontam que o planejamento da gravidez em mulheres portadoras de DM tem um impacto significativo na redução de riscos materno-fetais 4,9,20 . Quando se avaliaram os cuidados pré-concepcionais oferecidos a essas mulheres, verificou-se que alguns parâmetros ficaram aquém do esperado, o fato de não se ter registrado nenhuma melhora na proporção de gestantes que tiveram consulta pré-concepcional foi desapontador.…”

“…Com o intuito de melhorar o prognóstico obstétrico, a importância da avaliação pré-concepcional de mulheres com DM tipo 1 ou tipo 2 não deve ser negligenciada. O mau controle metabólico no período da organogênese associa-se a um aumento da taxa de aborto espontâneo e de malformações fetais 4,5 . Durante o tempo de gestação subsequente aumenta o risco de macrossomia e das suas comorbidades associadas.…”