Endocrine Abstracts

Introduction: Our aim was to evaluate the effectiveness of a regional prepregnancy care (PPC) programme for women with both types 1 and 2 diabetes.

Methods: This prospective cohort study included women with pregestational diabetes attending five antenatal centres in the West of Ireland between January 2006 and December 2013. Comparisons were made between those that did and did not attend the PPC programme. Primary outcomes included composite adverse neonatal outcome (shoulder dystocia, congenital malformation, stillbirth, or neonatal death), macrosomia, caesarean delivery, admission to neonatal care unit, per trimester HbA1c, and prepregnancy folic acid use.

Results: In total 452 women were included, 275 (60.8%) with type 1 diabetes and 177 (39.2%) with type 2 diabetes. PPC was attended by 148 (32.7%) women. Those who attended PPC were older (33.8 versus 31.8 years, P<0.01) and a higher proportion used prepregnancy folic acid (96.6% vs 54.9%, P<0.01). Mean first trimester HbA1c was lower among those who attended PPC (6.9% vs 7.8%, P<0.01), as was the mean second trimester HbA1c (6.6% vs 6.2%, P<0.01). There was no significant difference in third trimester HbA1c between groups. Rates of adverse neonatal outcomes were higher in those that did not attend PPC (9.5% vs 4.1%, P=0.04). A lower proportion of infants born to women who attended PPC required neonatal unit admission (37.2% vs 48.7%, P=0.02). There was no difference in rates of caesarean delivery or macrosomia between groups. Binary logistic regression analysis identified that attendance at PPC independently reduced the odds of a serious adverse neonatal outcome (aOR 0.27, CI 0.09–0.83, P=0.02).

Conclusion: These findings suggest that provision of a regional PPC programme confers both an individual and economic benefit and should be available to all women with pregestational diabetes.

Disclosure: This work was supported by the Health Research Board of Ireland.