Improving Outcomes of Pregnancy for Women with Type 1 and Type 2 Diabetes
Improving Outcomes of Pregnancy for Women with Type 1 and Type 2 Diabetes
The pregnancy outcomes for women with type 1 diabetes remain poor with increased risk of major congenital malformation, stillbirth, premature delivery and perinatal death compared to the background maternity population. Despite clear evidence that women who attend prepregnancy care have improved blood glucose control with reduced risk of serious adverse outcomes, only a minority of women attend these clinics. For women with type 2 diabetes who are older, more obese and more likely to belong to an ethnic minority or live in an area of social deprivation, pregnancy outcomes are at least as poor as for women with type 1 diabetes. This is important as the prevalence of type 2 diabetes in women of reproductive years is increasing and even fewer women with type 2 diabetes attend prepregnancy care or take folic acid supplementation. Greater awareness regarding the risks among women with diabetes as well as primary and secondary healthcare professionals is required, if pregnancy outcomes are to be improved.
Women with diabetes have a 2-3-fold increased risk of having a baby with a major congenital malformation, compared with women in the general population. For women with type 1 diabetes with poor glycaemic control during the first seven weeks of pregnancy, the risk of major malformation may be as high as 20-25%. More recently it has been shown that the outcomes of pregnancy in women with type 2 diabetes are also significantly worse compared to the general population and are at least as poor as for women with type 1 diabetes. Some studies, including our own regional data, suggest that women with type 2 diabetes, who are older, more obese and more likely to belong to an ethnic minority group, may have poorer pregnancy outcomes than women with type 1 diabetes.
It is now almost 20 years since it was shown that women with PPC had a significantly lower rate of congenital anomalies (4.9% vs. 9.0%) compared to women who received care after conception. These benefits have since been confirmed by several specialist centres, in regional US programmes and in a large unselected clinic population in the UK. Despite this, poor preparation for pregnancy prevails, with only 38% of women with type 1 diabetes and of 25% women with type 2 diabetes attending PPC in the UK. The challenge for us now is to use the experiences gained from running specialist PPC services in individual centres, to develop, co-ordinate and implement more effective PPC strategies accessible to a broader range of women with both type 1 and type 2 diabetes.
Abstract and Background
Abstract
The pregnancy outcomes for women with type 1 diabetes remain poor with increased risk of major congenital malformation, stillbirth, premature delivery and perinatal death compared to the background maternity population. Despite clear evidence that women who attend prepregnancy care have improved blood glucose control with reduced risk of serious adverse outcomes, only a minority of women attend these clinics. For women with type 2 diabetes who are older, more obese and more likely to belong to an ethnic minority or live in an area of social deprivation, pregnancy outcomes are at least as poor as for women with type 1 diabetes. This is important as the prevalence of type 2 diabetes in women of reproductive years is increasing and even fewer women with type 2 diabetes attend prepregnancy care or take folic acid supplementation. Greater awareness regarding the risks among women with diabetes as well as primary and secondary healthcare professionals is required, if pregnancy outcomes are to be improved.
Background
Women with diabetes have a 2-3-fold increased risk of having a baby with a major congenital malformation, compared with women in the general population. For women with type 1 diabetes with poor glycaemic control during the first seven weeks of pregnancy, the risk of major malformation may be as high as 20-25%. More recently it has been shown that the outcomes of pregnancy in women with type 2 diabetes are also significantly worse compared to the general population and are at least as poor as for women with type 1 diabetes. Some studies, including our own regional data, suggest that women with type 2 diabetes, who are older, more obese and more likely to belong to an ethnic minority group, may have poorer pregnancy outcomes than women with type 1 diabetes.
It is now almost 20 years since it was shown that women with PPC had a significantly lower rate of congenital anomalies (4.9% vs. 9.0%) compared to women who received care after conception. These benefits have since been confirmed by several specialist centres, in regional US programmes and in a large unselected clinic population in the UK. Despite this, poor preparation for pregnancy prevails, with only 38% of women with type 1 diabetes and of 25% women with type 2 diabetes attending PPC in the UK. The challenge for us now is to use the experiences gained from running specialist PPC services in individual centres, to develop, co-ordinate and implement more effective PPC strategies accessible to a broader range of women with both type 1 and type 2 diabetes.
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