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Diabetes and pregnancy. Preconception care, pregnancy outcomes, resource utilization and costs
W H Herman1, N K Janz, M P Becker
1Department of Internal Medicine, School of Public Health, University of Michigan, Ann Arbor. wherman@umich.edu
Objective:
To describe and compare pregnancy outcomes, resource utilization and costs among women with diabetes who receive and do not receive preconception care.
Study Design:
A multicenter, prospective, observational study of women with type 1 diabetes who received preconception care (PC), became pregnant and delivered (PC women) and women with type 1 diabetes who received prenatal care (PC) only and delivered (PN women).
Results:
As compared to PN women (n = 74), PC women (n = 24) were seen earlier in gestation and had significantly lower glycosylated hemoglobin levels. The combined number of outpatient visits for PC women was not greater than for PN women. PC women were hospitalized significantly less during pregnancy and tended to have shorter inpatient stays. The mean length of stay after delivery was significantly shorter for PC women. Intensity of care tended to be lower and length of stay shorter for infants of mothers who received PC care. The net cost saving associated with PC care was approximately $34,000 per patient.
Conclusion:
PC achieves its major intended health benefits and is associated with reduced resource utilization and substantially reduced costs. For both health and economic reasons, clinical practice and public policy should embrace PC.