Pre-gestational diabetes is associated with increased risk of adverse obstetric and neonatal outcomes, although adherence to current guidelines including preconception counselling, intensive blood glucose management and consideration of induction of labour at 38 weeks can help to optimize outcomes for these women. We conducted a single centre retrospective review of patient charts coded for diabetes in pregnancy over a four year period, to assess obstetric and neonatal outcomes.
71 pregnancies in 67 women were reviewed, 40 (58%) had T1DM and 29 (42%) T2DM, and 2 women with MODY. Rates of preconception counseling, including the use of high dose folate was low, as was pre-pregnancy recording of Hba1c only 36% (T2 41% vs T1 32%). Women with T1DM had higher rates of premature delivery (55% vs 24%), LGA (52.5% vs 45%) and IUFD (2 cases associated with DKA vs 0), however PET was equally prevalent (15% vs 17%). Rate of induction of labour was 46% (T1DM 50% vs T2DM 41%), and half of inductions required delivery by caesarean section. Consistent with other series total caesarean section rate was 64%. Almost all (96%) babies were monitored in special care nursery, for an average duration of 2.5 days.
This series provides up to date local information to guide counselling of women of child bearing age with diabetes, including a reminder to endocrinologists of the importance of pro-active counselling due to high rates of unplanned or inadequately planned pregnancy.