Pragmatic community-based pre-pregnancy care (PPC) programs can improve clinical outcomes in women with type 2 diabetes, according to a new study published in Diabetologia.
Investigators note that, “[t]here is an unmet need to improve women’s and healthcare professionals’ awareness about diabetes pregnancy risks and how they can be minimized by optimal pregnancy preparation.”
To address this need, an integrated community-based PPC program was developed and created for women with pre-existing diabetes (including type 1 and type 2 diabetes). Investigators assessed the effectiveness of the PPC program in improving pregnancy preparation and outcomes. A total of 4558 women and 306 primary care practices actively participated in the PPC program.
Of the 842 consecutive pregnancies in women with diabetes, 502 occurred before and 340 after the intervention. During and after the PPC intervention, pregnant women with type 2 diabetes were more likely to achieve target glycated hemoglobin A1c (HbA1c) levels ≤48 mmol/mol compared with women who did not participate (44.4% of women before vs 58.5% of women during/after PPC intervention; P =.016).
Folic acid supplementation was also improved (23.5% and 41.8%; P =.001), along with a nearly 3-fold improvement in being optimally prepared for pregnancy in women with type 2 diabetes (5.8% and 15.1%; P =.021). Women with type 1 diabetes presented earlier for antenatal care during/after PPC (54.0% vs 67.3% before 8 weeks’ gestation; P =.003).
“Although most women (85%) with type 2 diabetes were not optimally prepared for pregnancy, there was an overall 3-fold improvement in pregnancy preparation measures,” the investigators write.
Yamamoto JM, Hughes DJF, Evans ML, et al. Community-based pre-pregnancy care programme improves pregnancy preparation in women with pregestational diabetes [published online May 9, 2018]. Diabetologia. doi:10.1007/s00125-018-4613-3