Author(s): Samad S.; Dawes S.; West K.
Source: Diabetic Medicine; Mar 2019; vol. 36 ; p. 22-23
Publication Date: Mar 2019
Publication Type(s): Conference Abstract
Available at Diabetic Medicine – from Wiley Online Library Full Collection
Abstract:Aims: To evaluate the impact of a new dedicated pre-pregnancy optimisation service on glycaemic and pregnancy outcomes. This service offers monthly consultant appointments, up to fortnightly DSN appointments and access to dietitians and psychologists. Method(s): Data was collected from our trust electronic record system for all women referred to this clinic between May 2013 and February 2018. Result(s): Of the 63 women referred, 75% had Type 1 diabetes, 23% Type 2 diabetes; the remainder had MODY with average age 31.6 years (range 22.2-44.5 years). 66% were referred from secondary care services, 22% from community diabetes or primary care and 11% from obstetric and fertility services. The most prevalent primary interventions were intensive DSN support (22%) and insulin titration 22%. 9% were women with Type 2 diabetes put on to safer medication. Other interventions included pump initiation (8%) and carbohydrate counting alone (11%). HBA1C at referral compared to final clinic visit: HBA1C <=50mmol/mol 6.2% vs 12.5%, HBA1C between 51 and 60mmol/mol: 15.4% vs 39.6% and HBA1C >=89mmol/mol: 15.4% vs 4.2%. In this cohort, 37% have completed a successful pregnancy, 12% are currently pregnant and 14% are still optimising glycaemic control. 19% are no longer planning pregnancy. Of the 30 pregnancies in this group, three resulted in early miscarriage but there were no congenital abnormalities. All optimised patients were on 5mg folic acid at conception. Conclusion(s): A dedicated optimisation service can move diabetic women from high risk for pregnancy to low risk, although a range of different interventions with regular intensive input are required.