Ten years of optimizing outcomes for women with type 1 and type 2 diabetes in pregnancy - the Atlantic DIP experience.

Ten years of optimizing outcomes for women with type 1 and type 2 diabetes in pregnancy - the Atlantic DIP experience.

J Clin Endocrinol Metab. 2016 Jan 28;:jc20153817

Authors: Owens LA, Egan AM, Carmody L, Dunne F

Abstract
CONTEXT: Pregnancy for women with type 1 or type 2 diabetes is a time of increased risk for both mother and baby. The Atlantic Diabetes in pregnancy program provides coordinated, evidence-based care for women with diabetes in Ireland. Founded in 2005 we now share outcomes over our first decade in caring for pregnant women with diabetes.
OBJECTIVE: The objective was to assess improvements in clinical outcomes after introduction of interventions.
DESIGN, SETTING, PARTICIPANTS: We retrospectively examined 445 pregnancies in women with Type 1 and Type 2 diabetes and compared them over two time points, 2005-2009,2010-2014.
INTERVENTIONS: Interventions introduced over that time include; provision of combined antenatal/diabetes clinics, pre-pregnancy care, electronic data management, local clinical care guidelines, professional and patient education materials, an app and website.
MAIN OUTCOMES MEASURED: Pregnancy outcomes Results: The introduction of the Atlantic DIP program has been associated with a reduction in adverse neonatal outcomes. There has been a reduction in congenital malformations (5% to 1.8%,p=0.04), stillbirths (2.3 v 0.4%,P=0.09), despite an upward trend in maternal age (mean age 31.7 v 33), obesity (29% v 43% BMI>30kg/m(2)) and excessive gestational weight gain (24% v 38%,p=0.002). These improvements in outcomes occur alongside an increase in attendance at pre-pregnancy care (23% to 49%,p<0.001), use of folic acid (45 v 71%,p<0.001) and sustained improvement in glycemic control.
CONCLUSIONS: Changing the process of clinical care delivery and utilizing evidence-based interventions in a pragmatic clinical setting improves pregnancy outcomes for women with pre-gestational diabetes. We now need to target optimization of maternal body mass index prior to pregnancy and put a greater focus on gestational weight gain through education and monitoring.

PMID: 26820715 [PubMed - as supplied by publisher]

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