Pregnancy in women with Type 1 Diabetes Mellitus (T1DM) is associated with increased incidence of adverse maternal and fetal outcomes compared to the non-diabetic population. One of the well-established strategies to avoid these adverse outcomes is to optimise diabetes management prior to conception, termed as pre-conception care. We performed a retrospective audit of pregnant women with Type 1 Diabetes with the aim to investigate the proportion of women who have received optimal preconception care and to study the neonatal and obstetric outcomes of these women.
Case notes of all pregnant women with Type 1 diabetes who attended the Flinders Medical Centre (FMC) high-risk pregnancy clinic or delivered at FMC between 1/1/2014 and 1/1/2015 were reviewed. Data on pre-conception care and pregnancy outcomes was collected and compared to the pre-conception guidelines set out in the South Australian Perinatal Practice Guidelines (SA PPG), and Australian Diabetes in Pregnancy Society (ADIPS) guidelines and the South Australian pregnancy outcomes for 2014.
The major proportion of women had no pre-conception care with only six presenting for pre-conception visits. A total of 67% of women had a HbA1c performed in the 3 months prior to conception and of those, only 14% had a recommended HbA1c of < 6%. There was an increased rate of maternal and neonatal complications compared to the general population.
Our audit results show that pre-conception care is sub-optimal and there is an increased incidence of adverse maternal and neonatal outcomes in women with type 1 diabetes, which can potentially be avoided by ensuring optimization of diabetes management prior to conception. There is a need to develop effective strategies to facilitate optimal preconception care.