Endocrine Abstracts

Pregnancy for women with type 1 or type 2 diabetes is a high-risk time. The Atlantic diabetes in pregnancy (DIP) programme aims to provide coordinated, optimal evidence-based clinical care for women with diabetes over five hospital centres in the West of Ireland. After previously auditing pregnancy outcomes in 2008 and again in 2011 we now look at our 10-year outcomes. Changes in clinical care delivery that have occurred over that time include; the provision of dedicated combined antenatal/diabetes clinics, pre-pregnancy care clinics delivered by specialist diabetes and obstetric staff, use of a diabetes electronic management system, use of locally developed clinical care guidelines and professional and patient education materials. We examined outcomes in 440 pregnancies, divided into groups in groups of pre- and post-audit cycles, after which further change was implemented (2005–2008, 2009–2011, and 2012–2014). We saw a trend towards reduction in a lot of major outcomes. This is despite an increase in maternal age, maternal weight/BMI and a significant increase in numbers of women obese at the start of pregnancy. There has been an overall significant reduction in gestational weight gain. There has not however been a reduction amongst overweight women, just obese and normal weight women. We also saw an increase in attendance at pre-pregnancy care and a reduction in mean HbA1c values. There has been a significant reduction in congenital malformations and a non-significant reduction in large for gestational age babies, birth weight, smoking, neonatal hypoglycaemia, jaundice and admissions to the neonatal intensive care unit.

Conclusion: Changing the process of clinical care delivery can improve outcomes in women with pregestational diabetes. We now need to target women prior to pregnancy in order to optimise BMI.

Disclosure: Health Research Board of Ireland.