The 2002-3 national survey of diabetic pregnancy (CEMACH)1 confirmed the continued poor outcomes in diabetic pregnancy.
Pregnancies in a consecutive cohort of 197 type 1 diabetic women who reached the second trimester between 1998-2010 were studied. They were managed by the same team in an individualised manner using standard protocols and their outcomes compared to CEMACH data.
Factors reflecting pre-pregnancy care such as pre-conception counselling, use of folic acid and early HbA1c values did not differ significantly from CEMACH. Deprivation was significantly more common with 48% in the most deprived quintile compared to 22% in CEMACH. Despite this the median gestation at first assessment was 56 days. However there was a higher rate of congenital malformations than in CEMACH (86/1000 v. 48/1000, p<0.03) which did not appear to relate to deprivation, but more to lack of pre-pregnancy care.
There were 2 ante-partum stillbirths at 26 and 37 weeks (10/1000) compared to CEMACH (26/1000). The caesarean section rate was less than CEMACH (52% v. 67% p<0.0001). There was a trend towards less preterm deliveries in our cohort (31% v. 37%). Significantly less babies in our cohort had birthweights >90th centile (41% v 52%, p<0.005) and less babies in our cohort were separated from their mothers by admission to special care units (39% v 51%, p<0.0001)
In conclusion it appears that centralisation of care of type 1 diabetic pregnancy to larger units able to individualise care may be associated with more normal obstetric outcomes; however pre-pregnancy preparation remains a major issue. Confidential Enquiry into Maternal and Child Health.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.