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Ten years of optimizing outcomes for women with type 1 and type 2 diabetes in pregnancy—the atlantic dip experience
Owens, Lisa A.; Egan, Aoife M.; Carmody, Louise; Dunne, Fidelma
Context: Pregnancy for women with type 1 or type 2 diabetes is a time of increased risk for both mother and baby. The Atlantic Diabetes in Pregnancy program provides coordinated, evidence-based care for women with diabetes in Ireland. Founded in 2005, the program now shares outcomes over its first decade in caring for pregnant women with diabetes. Objective: The objective was to assess improvements in clinical outcomes after the introduction of interventions. Design, Setting, Participants: We retrospectively examined 445 pregnancies in women with type 1 and type 2 diabetes and compared them over two timepoints, 2005-2009 and 2010-2014. Interventions: Interventions introduced over that time include: provision of combined antenatal/diabetes clinics, prepregnancy care, electronic data management, local clinical care guidelines, professional and patient education materials, an app, and a web site. Main Outcomes: Pregnancy outcomes were measured. Results: The introduction of the Atlantic Diabetes in Pregnancy program has been associated with a reduction in adverse neonatal outcomes. There has been a reduction in congenital malformations (5 to 1.8%; P = .04), stillbirths (2.3 vs 0.4%; P = .09), despite an upward trend in maternal age (mean age, 31.7 vs 33 years), obesity (29 vs 43%; body mass index >30 kg/m(2)), and excessive gestational weight gain (24 vs 38%; P = .002). These improvements in outcomes occur alongside an increase in attendance at prepregnancy care (23 to 49%; P = .001), use of folic acid (45 vs 71%; P = .001), and sustained improvement in glycemic control. Conclusions: Changing the process of clinical care delivery and utilizing evidence-based interventions in a pragmatic clinical setting improves pregnancy outcomes for women with pregestational diabetes. We now need to target optimization of maternal body mass index before pregnancy and put a greater focus on gestational weight gain through education and monitoring.
Keyword(s): gestational weight-gain; congenital-malformations; prepregnancy care; preconception care; cesarean-section; fetal outcomes; risk; insulin; metformin; metaanalysis
Publication Date:
Type: Journal article
Peer-Reviewed: Unknown
Institution: NUI Galway
Publisher(s): The Endocrine Society
First Indexed: 2019-03-23 07:01:50 Last Updated: 2019-09-20 06:48:30