Abstract
Background: Poor diabetes management prior to pregnancy results in increased risk of adverse pregnancy outcomes, such as congenital malformation and stillbirth. The purpose of this study is to develop an integrated, population-based, pre-pregnancy programme to improve pregnancy outcomes in women of reproductive age with diabetes in South Western Sydney.
Methods: The strategy comprised (i) a systematic literature review of pre-pregnancy programmes for women with diabetes; (ii) a chart review of pregnancy outcomes (e.g. congenital malformations, stillbirths and caesarean sections) in with type 1 diabetes (T1D) and type 2 diabetes (T2D) (n = 74) between 2010 and 2015; (iii) surveys of local healthcare professionals (n = 12) and women with diabetes who had a pregnancy (n = 15); (iv) two focus groups – one including women with T1D, and another of women with T2D from cultural and linguistically different backgrounds- and (v) two meetings, one comprising primary health care professionals, followed by a Delphi-group meeting of multidisciplinary inter-sectoral professionals.
Results: Our literature review showed that multifaceted programmes were a better approach to significantly increase contraception uptake, and to reduce adverse outcomes (i.e. malformation, stillbirth, or neonatal mortality). Our chart-review showed that the rates of pregnancy outcomes were similar in women with T1D and T2D (e.g. major congenital malformations [18.2% vs 13.5%] and emergency caesarean sections [21.9% vs 23.1%] respectively). Lack of knowledge of contraception options and poor pregnancy outcomes, as well as limited access to pre-pregnancy care were barriers in women with diabetes. The meetings led to a consensus to develop: a) a structured approach to identification and management/self-management of women of childbearing age with diabetes and; b) a multi-faceted district-wide educational programme for healthcare professionals and women with diabetes.
Conclusion: Sufficient evidence exists for consensus on a district-wide strategy to improve pre-pregnancy management among women with pre-existing diabetes.