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Fifteen‐year trends and predictors of preparation for pregnancy in women with pre‐conception Type 1 and Type 2 diabetes: a population‐based cohort study
Author(s) -
Glinianaia S. V.,
Tennant P. W. G.,
Crowder D.,
Nayar R.,
Bell R.
Publication year - 2014
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.12460
Subject(s) - medicine , odds ratio , type 2 diabetes , pregnancy , obstetrics , diabetes mellitus , logistic regression , population , attendance , cohort , demography , endocrinology , environmental health , sociology , biology , economic growth , economics , genetics
Aims To investigate trends in indicators of preparation for pregnancy in women with Type 1 and Type 2 diabetes and explore their predictors. Methods Data on 2293 pregnancies delivered during 1996–2010 by women with Type 1 ( n = 1753) and Type 2 ( n = 540) diabetes were obtained from the Northern Diabetes in Pregnancy Survey. Multiple logistic regression was used to analyse the relationship between potential predictors and three indicators of inadequate pregnancy preparation: non‐attendance for pre‐conception care; no pre‐conception folate consumption; and peri‐conception HbA 1c ≥ 53 mmol/mol (≥ 7%). Results Overall, 40.3% of women with diabetes attended pre‐conception care, 37.4% reported pre‐conception folate consumption, and 28.2% had adequate peri‐conception HbA 1c . For all patients, pre‐conception folate consumption improved over time, while peri‐conception glucose control did not. Attendance for pre‐conception care for women with Type 1 diabetes significantly declined. Residence in deprived areas, smoking and younger maternal age (for women aged < 35 years) were independently associated with all three indicators of inadequate preparation for pregnancy. Additional predictors of inadequate peri‐conception HbA 1c were: Type 1 diabetes (adjusted odds ratio 5.51, 95% CI 2.71–11.22), longer diabetes history (adjusted odds ratio 1.16, 95% CI 1.09–1.23 per year increase for those with < 15 years' diabetes duration), non‐white ethnicity (adjusted odds ratio 3.13, 95% CI 1.23–7.97) and higher BMI (adjusted odds ratio 1.05, 95% CI 1.01–1.09 per 1‐kg/m 2 increase). Non‐attendance for pre‐conception care was additionally associated with Type 2 diabetes ( P = 0.003) and multiparity ( P < 0.0001). Conclusions There are socio‐demographic inequalities in preparation for pregnancy among women with diabetes. Women with Type 2 diabetes were less likely to attend pre‐conception care. Pre‐conception services need to be designed to maximize uptake in all groups.