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Detailed description of a prepregnancy care program and its impact on maternal glucose control, weight gain, and dropouts
Author(s) -
Perea Verónica,
Orois Aida,
Amor Antonio J.,
Jansà Marga,
Vidal Merce,
Gimenez Marga,
Conget Ignacio,
Vinagre Irene
Publication year - 2017
Publication title -
diabetes/metabolism research and reviews
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.307
H-Index - 110
eISSN - 1520-7560
pISSN - 1520-7552
DOI - 10.1002/dmrr.2838
Subject(s) - medicine , glycemic , hypoglycemia , interquartile range , odds ratio , confidence interval , retrospective cohort study , diabetes mellitus , weight gain , type 2 diabetes , metabolic control analysis , endocrinology , body weight
Background The aim of this study was to analyze the clinical and metabolic changes observed during a prepregnancy care (PPC) program. Methods We performed a retrospective, observational, cohort study of 104 women with type 1 diabetes initiating a PPC program from 2011 to 2014. The outcomes measured were changes in HbA 1c levels, weight and hypoglycemic events during PPC. Risk factors associated with severe hypoglycemia events, achieving the HbA 1c target and dropouts were evaluated. Results HbA 1c decreased from 7.2 ± 0.8% (55.3 ± 8.8 mmol/mol) to 6.7 ± 0.9% (49.8 ± 10.3 mmol/mol) ( P < .001) within a median of 14.2 months (interquartile interval 5.4‐23.2); 71.2% obtained HbA 1c < 7% (53 mmol/mol). HbA 1c at the end of PPC was associated with baseline HbA 1c (β = .318, P = .001) and the number of previous pregnancies (β = .224, P = .038), PPC was accompanied by 1.4 ± 4.0 kg weight gain ( P = .003) without changes in severe hypoglycemic events. The risk factors for severe hypoglycemia were severe hypoglycemic events during the 2 years before (odds ratio [OR] 11.99, confidence interval 95% 1.89‐75.95) and PPC duration (OR 1.09, 1.03‐1.16). A total of 33 patients (31.7%) dropped out from PPC during follow‐up, with dropout being associated with age (OR 1.17, 1.04‐1.36) and PPC duration (OR 1.06, 1.02‐1.11). Conclusions Our PPC program was associated with an improvement in glycemic control without a significant increase in severe hypoglycemic events, although with some weight gain. A considerable number of patients dropped out during follow‐up, this being related to older age and a longer duration of the program. This information could be of help to design new and more effective PPC approaches. Copyright © 2016 John Wiley & Sons, Ltd.