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Care of women with diabetes before, during and after pregnancy: time for a new approach?
Author(s) -
Egan A. M.,
Carmody L.,
Kirwan B.,
Dunne F. P.
Publication year - 2017
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.13342
Subject(s) - medicine , pregnancy , type 2 diabetes , diabetes mellitus , obstetrics , post partum , postpartum period , diabetes in pregnancy , type 1 diabetes , gynecology , gestation , gestational diabetes , endocrinology , genetics , biology
Aims This study assesses the impact of pregnancy and pre‐pregnancy care on longer‐term treatment goals in women with diabetes. Methods This retrospective study included women with Type 1 ( n = 247) and Type 2 diabetes ( n = 137) who were evaluated before, during and after pregnancy. Results Among women with Type 1 diabetes, average HbA 1c at 12 months post‐partum was similar to the preconception level [63 vs. 64 mmol/mol (7.9% vs. 8.0%), P = 0.60]. This was also the case for women with Type 2 diabetes [52 vs. 52 mmol/mol (6.9% vs. 6.9%), P = 0.79]. At 12 months post‐partum, there was no improvement in other measures of diabetes control and one in five women are lost to follow‐up from clinical care. In total, 44.9% of women with Type 1 diabetes and 27.7% of those with Type 2 diabetes attended pre‐pregnancy care. Attendees maintained superior glycaemic control throughout the study and were more likely to be receiving specialist care post‐partum. Conclusions These findings identify a need to change our approach to the reproductive care of women with diabetes. In particular, efforts should be made to ensure all women have access to and attend pre‐pregnancy care, and barriers to engagement with post‐partum care should be addressed.