Outcome of pregnancy complicated by pre-gestational diabetes--improvement in outcomes

Pre-gestational diabetes mellitus (DM) is associated with adverse fetal and maternal outcomes. We have previously reported outcomes for women with DM. To determine whether review, and discussion of the results, affected outcomes, pregnancies in women with DM from July 1998 to July 2001 were examined in a prospective cohort study. The results were then compared to the results from the previous review.

Thirty-five pregnancies were included (24 in 20 women with Type 1 DM, 11 in 11 with Type 2 DM). Type 1 women were more likely to be Caucasian (100% versus 22.2%, p < 0.0001), and had a longer duration of diabetes (13 +/- 6 versus 3 +/- 2 years, p < 0.0001).

Pregnancy planning rates improved significantly for Type 1 DM (62.5% planned versus 18.9% in original study p = 0.01), and did not change for Type 2 DM. Caesarean section (LSCS) rate was high in the original study, particularly in Type 1 DM (77%), and was lower after review (47.6% in Type 1 DM p < 0.05 compared to original study, and 44.4% in Type2 DM, p = ns). Planning was associated with lower HbA1c before and during pregnancy (6.0 +/- 1.4% versus 8.1 +/- 1.8% (p = 0.0035), and 5.5 +/- 1 versus 6.5 +/- 1.5% (p < 0.001)), greater gestational age at delivery (38.2 versus 36.2 weeks p = 0.0318) and lower rate of LSCS (31.6% versus 72.7% (p = 0.0295)).

It is important to continue improving pre-pregnancy planning. Extensive discussions involving a multi-disciplinary team improved planning rates and decreased the LSCS rate while maintaining outcomes.