P281 Impact of pre-pregnancy counselling on HbA1c level and pregnancy outcomes in women with pre-existing diabetes

Published Date: 25th April 2023

Publication Authors: Collings S, Christian S, Pankaja S, McNulty S, Davies H, Milne R, Gallagher CG, Bujawansa S

Aims
The aim of our study was to assess uptake of pre-pregnancy counselling and its impact on HbA1c level. We looked to establish whether lower HbA1c levels and counselling improved outcomes in pregnant women with pre-existing diabetes.

Methods
Electronic record of all pregnant women with pre-existing diabetes booked between January to December 2021 (N = 53) at the Trust were reviewed retrospectively. Data were collected on demographics (age, ethnic origin, body mass index, type of diabetes), pre-pregnancy counselling, HbA1c level in each trimester, outcome of pregnancy, mode of delivery, birth centiles and neonatal admission.

Results
Majority (83%) of the women were not prepared for pregnancy. Only 29% of women with type 1 diabetes and 8% of women with type 2 diabetes attended the pre-pregnancy clinic. 85% of miscarriages were in women who did not attend counselling. Among the women with HbA1c > 48mmol/mol, 80% did not have counselling. Higher HbA1c was associated with increased rate of miscarriage and higher birth centiles. Of the 9 women with HbA1c >86mmol/mol, five had miscarriage (56%) compared to none with normal HbA1c (<42mmol/mol). Birth centile above 90 was noted in 50% of women with HbA1c > 48mmol/mol unlike women with normal HbA1c (28.5%).

Conclusion
Improved control of diabetes pre-pregnancy leads to improved outcomes with lower miscarriage rates and fewer babies weighing >90th centile. There is need to improve uptake of pre-pregnancy counselling. We recommend educating staff in primary care, early pregnancy, and fertility clinics to increase referrals to pre-pregnancy services.


Collings, S; Christian, S; Pankaja, S; McNulty, S; Davies, H; Milne, R; Gallagher, C; Bujawansa, S. (2023). P281 Impact of pre-pregnancy counselling on HbA1c level and pregnancy outcomes in women with pre-existing diabetes. Diabetic Medicine. 40(Suppl 1), p.151. [Online]. Available at: https://dx.doi.org/10.1111/dme.15048 [Accessed 11 July 2023]

 

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