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Type-2 diabetes mellitus: does prenatal care affect outcomes?
Allison J Allen1, Jonathan M Snowden1, Bernard Lau1
1a Department of Obstetrics and Gynecology , Oregon Health and Science University , OR , USA.
Summary
Timely prenatal care significantly reduces adverse outcomes for pregnant women with Type-2 diabetes mellitus (T2DM). Early care, especially in the first trimester, lowers risks of intrauterine fetal demise and preterm birth.
Area of Science:
- Perinatal Medicine
- Endocrinology
- Public Health
Background:
- Type-2 diabetes mellitus (T2DM) in pregnancy presents significant risks for both mother and fetus.
- Adverse perinatal outcomes are a major concern in pregnancies complicated by T2DM.
- The impact of timing of prenatal care initiation on these outcomes requires further investigation.
Purpose of the Study:
- To evaluate the association between the timing of prenatal care initiation and adverse perinatal outcomes in pregnant women with pregestational Type-2 diabetes mellitus.
- To identify specific risks associated with delayed or absent prenatal care in this high-risk population.
Main Methods:
- Retrospective cohort study utilizing linked vital statistics and birth certificate data from California (1997-2006).
- Pregnant women with pregestational diabetes were stratified by trimester of first prenatal care visit or delivery without prior care.
- Outcomes including intrauterine fetal demise (IUFD), preterm birth, macrosomia, preeclampsia, and cesarean delivery were compared across cohorts using chi-squared tests and logistic regression.
Main Results:
- Women presenting for care at delivery had a significantly higher risk of IUFD (11.3%) compared to those presenting in the first trimester (0.9%).
- Late presentation was also associated with increased preterm birth rates (29.4% vs. 21.0%).
- Adjusted odds ratios confirmed statistically significant associations for IUFD (11.37) and preterm delivery (1.55) with late care. No differences in macrosomia or preeclampsia were observed.
Conclusions:
- Initiating prenatal care in the first trimester is crucial for improving perinatal outcomes in women with Type-2 diabetes mellitus.
- Delayed or absent prenatal care is strongly linked to increased risks of intrauterine fetal demise and preterm birth.
- Effective management of T2DM throughout pregnancy through timely care is essential for better maternal and neonatal health.
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