Endocrine Abstracts

Background: Preconception planning is essential for a successful pregnancy in women with pregestational diabetes,although many women still do not plan their pregnancies. The rapid outbreak of T2DM among the general population, including women of childbearing age, is one of the largest public health issues. The aim of this study is to describe time trends in preconception planning, obstetric and perinatal outcomesduring the past 8 years in ourpregestational care unit, focusing on T2DM.

Material and methods: We performed a retrospective case study of all deliveries of pregnant T2DM or T1DM women followed in our unit from 2009 to 2016 (n=114). Wedescribed clinical data, preconception care, pregnancy and neonatal outcomes, comparing the results: 1) among T1DM (n=68) and T2DM (n=46) and 2) T2DM pregnancies between different periods of time (2009–2012 vs. 2013–2016). We analyzeddata, evaluating differences using χ² test, Student’ t-test or Mann–Whitney test.

Results: As compared with T1DM pregnant, T2DM pregnant wereolder (age: 33.9±4.9 vs. 31.0±4.5 years [mean±S.D.]; P 0.002) and had less duration of diabetes (2 (1–5) vs. 14 (6–20.8) years [median (P25–P75)]; P 0.000). T2DM had less pre-conception care (15.2 vs 54.4%; P 0.000) and higher parity (nulliparous: 15.2 vs 42.6%; P0.002). 40% of T2DM pregnantwere obese (17.9% of T1DM; P 0.01) but had less total pregnancy weight gain (4.9 (2.6–10.1) vs. 11.2 (5.1–14.3) kg; P 0.001). No differences between HbA1c levels at pregnancy diagnosis (6.7% (6.1–7.4)) or during 1rst trimester (6.5% (6.0–7.2)) were detected, butduring 2nd and 3rd trimester T2DM were more likely to achieve lower glucose levels (HbA1c: 5.7%(5.6–6.1) and 5.9% (5.6–6.2) vs. 6.2% (5.8–6.5) and 6.3% (5.9–6.5);P 0.000 and P 0.001). There were no differences in obstetric and perinatal outcomes between T1DM and T2DM (risk of preeclampsia (PE): 8.8%, preterm delivery: 16.7%, cesarean section: 45.6%, newbornlarge for gestational age: 33.3%, neonatal hypoglycemia: 23%, congenital malformations: 20.2%, newborn’s admission to intensive care unit (ICU): 24.8%, perinatal mortality: 1.8%). Between 2013 and 2016, compared to the preceding 4 years, T2DM had more total pregnancy weight gain (7.2 (4.3–10.7) vs 2.9(1.3–5.1) kg; P 0.008) and a tendency of less pregnancy preparation (8.3 vs 22.7%; P 0.175). There was less proportion of PE (2.2 vs 15.6%; P 0.016) and less neonatal hypoglycemia (2.2% vs 15.6%; P 0.016) with no statistically significant differences in other outcomes, although a trend towards improvement was detected regarding preterm birth (8.3% vs 22.7%), c-section (25% vs 50%), newborn’s admission to ICU (13% vs 22.7%), and malformations (12.5% vs 18.2%).

Conclusion: Risk of pregnancy outcomes in T2DM pregnant are as high as in T1DM. Lately only 8.3% of T2DM had preconception management. It is crucial to enhance the need for pre-pregnancy preparation in this group to improve health outcomes.