Effectiveness of a regional prepregnancy care program in women with type 1 and type 2 diabetes

Murphy, Helen R, Roland, Jonathan M, Skinner, Timothy C, Simmons, David, Gurnell, Eleanor, Morrish, Nicholas J, Soo, Shiu-Ching, Kelly, Suzannah, Lim, Boon, Randall, Joanne, Thompsett, Sarah and Temple, Rosemary C (2010) Effectiveness of a regional prepregnancy care program in women with type 1 and type 2 diabetes. Diabetes Care, 33 (12). pp. 2514-2520. ISSN 0149-5992

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Abstract

OBJECTIVE: To implement and evaluate a regional prepregnancy care program in women with type 1 and type 2 diabetes. RESEARCH DESIGN AND METHODS: Prepregnancy care was promoted among patients and health professionals and delivered across 10 regional maternity units. A prospective cohort study of 680 pregnancies in women with type 1 and type 2 diabetes was performed. Primary outcomes were adverse pregnancy outcome (congenital malformation, stillbirth, or neonatal death), congenital malformation, and indicators of pregnancy preparation (5 mg folic acid, gestational age, and A1C). Comparisons were made with a historical cohort (n = 613 pregnancies) from the same units during 1999-2004. RESULTS: A total of 181 (27%) women attended, and 499 women (73%) did not attend prepregnancy care. Women with prepregnancy care presented earlier (6.7 vs. 7.7 weeks; P < 0.001), were more likely to take 5 mg preconception folic acid (88.2 vs. 26.7%; P < 0.0001) and had lower A1C levels (A1C 6.9 vs. 7.6%; P < 0.0001). They had fewer adverse pregnancy outcomes (1.3 vs. 7.8%; P = 0.009). Multivariate logistic regression confirmed that in addition to glycemic control, lack of prepregnancy care was independently associated with adverse outcome (odds ratio 0.2 [95% CI 0.05-0.89]; P = 0.03). Compared with 1999-2004, folic acid supplementation increased (40.7 vs. 32.5%; P = 0.006) and congenital malformations decreased (4.3 vs. 7.3%; P = 0.04). CONCLUSIONS: Regional prepregnancy care was associated with improved pregnancy preparation and reduced risk of adverse pregnancy outcome in type 1 and type 2 diabetes. Prepregnancy care had benefits beyond improved glycemic control and was a stronger predictor of pregnancy outcome than maternal obesity, ethnicity, or social disadvantage.

Item Type:	Article
Additional Information:	© 2010 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.
Uncontrolled Keywords:	adult,blood glucose,type 1 diabetes mellitus,type 2 diabetes mellitus,female,humans,pregnancy,pregnancy outcome,pregnancy in diabetics,prenatal care,risk factors,young adult,sdg 3 - good health and well-being ,/dk/atira/pure/sustainabledevelopmentgoals/good_health_and_well_being
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Groups > Cardiovascular and Metabolic Health Faculty of Medicine and Health Sciences > Research Centres > Metabolic Health
Depositing User:	Pure Connector
Date Deposited:	25 May 2016 16:01
Last Modified:	19 Oct 2023 01:42
URI:	https://ueaeprints.uea.ac.uk/id/eprint/59068
DOI:	10.2337/dc10-1113

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