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Prenatal interventions, education improve maternal, neonatal outcomes
A series of interventions implemented by a regional diabetes prepregnancy care program in Ireland reduced adverse neonatal outcomes over 10 years, including congenital malformations and stillbirth, and sustained improvement in maternal glycemic control during pregnancy, according to research in The Journal of Clinical Endocrinology & Metabolism.
In a retrospective follow-up study, Lisa A. Owens, MD, of the Atlantic Diabetes in Pregnancy program in Galway, Ireland, and colleagues analyzed data from 304 women with type 1 and type 2 diabetes with a total of 445 singleton pregnancies registered in the program between 2005 and 2014. Researchers compared pregnancy outcomes from women who delivered between 2005 and 2009 (n = 217; 134 with type 1 diabetes; 83 with type 2 diabetes) and between 2010 and 2014 (n = 228; 139 with type 1 diabetes; 89 with type 2 diabetes).
The Atlantic Diabetes in Pregnancy program, established in 2005, includes antenatal centers along the Irish Atlantic seaboard providing diabetes/antenatal care for a population of 500,000 with 11,000 deliveries annually. Interventions, all in place by 2010, included a structured prepregnancy care program that stressed optimization of glycemic control with a target HbA1c of 6.5% before pregnancy, prenatal folic acid use, and education about the prevention and treatment of hypoglycemia. Other interventions included structured regional diabetes/antenatal clinics with dedicated nurse specialists, obstetricians and diabetologists; electronic recording of pregnancy outcomes; development of local guidelines for health care professionals; patient information booklets; and a diabetes in pregnancy app.
Among mothers, researchers found a significant increase in attendance at structured prepregnancy care programs (from 23% to 49%) and folic acid intake before conception (from 45% to 71%). Mean first trimester HbA1c fell from 7.96% to 7.3% for women with type 1 diabetes and from 7.2% to 6.7% in women with type 2 diabetes; improvement was sustained through most pregnancies. Gestational weight gain, however, increased, with more mothers entering pregnancy with a BMI of 30 kg/m² or higher (29% to 43%; P = .02).
Researchers found a reduction in stillbirths, falling from 2.3% to 0.4% (P = .06), and in congenital malformations, which fell from 11% to 4% (P = .04). There were no changes observed in mean birth weight, babies born large or small for gestational age, preterm delivery rates or babies experiencing neonatal hypoglycemia.
“Going forward, we need to target women prior to pregnancy in order to optimize BMI and introduce a structured weight-management program during pregnancy to avoid excessive gestational weight gain, both of which will be associated with improved outcomes,” the researchers wrote. “Finally, new technologies, in particular real-time continuous glucose monitoring and insulin pump therapy, are likely to help a greater number of women achieve optimal glycemic control. Such technologies need to be freely available in clinical practice.” – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.