Trends in prevalence and outcomes of pregnancy in women with pre-existing type I and type II diabetes.
OBJECTIVE
To describe recent trends in prevalence, outcomes and indicators of care for women with pre-existing type I or type II diabetes.


METHODS
Regional population-based survey.


METHODS
All maternity units in the North of England.


METHODS
A total of 1258 pregnancies in women with pre-existing diabetes delivered between 1996 and 2004.


METHODS
Data from the Northern Diabetic Pregnancy Survey. Outcome of pregnancy cross-validated with the Northern Congenital Abnormality Survey and the Northern Perinatal Mortality Survey.


METHODS
Perinatal mortality, congenital anomaly and total adverse perinatal outcome (perinatal mortality and live births with congenital anomaly).


RESULTS
The prevalence of pregestational diabetes increased from 3.1 per 1000 births in 1996-98 to 4.7 per 1000 in 2002-04 (test for linear trend, P < 0.0001), driven mainly by a sharp increase in type II diabetes. Perinatal mortality declined from 48 per 1000 births in 1996-98 to 23 per 1000 in 2002-04 (P = 0.064). There was a significant reduction in total adverse perinatal outcome rate (P = 0.0194) from 142 per 1000 in 1996-98 to 86 per 1000 in 2002-04. There were substantial improvements in indicators of care before and during pregnancy and in glycaemic control throughout pregnancy, but indicators of preconceptual care, such as use of folic acid, remained disappointing.


CONCLUSIONS
We observed improvements in pregnancy care and outcomes for women with diabetes in a region with an established audit and feedback cycle. There remains considerable scope for further improvement, particularly in periconceptual glycaemic control. The rising prevalence of type II diabetes presents a challenge to further improvement.
Bell
R
R
Institute of Health and Society, Newcastle University, Newcastle-upon-Tyne, UK. ruth.bell@ncl.ac.uk
Bailey
K
K
Cresswell
T
T
Hawthorne
G
G
Critchley
J
J
Lewis-Barned
N
N
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D000013:Congenital Abnormalities / Q000453:epidemiology*; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000453:epidemiology*; D004739:England / Q000453:epidemiology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D054238:Perinatal Mortality; D011181:Postnatal Care / Q000706:statistics & numerical data; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D011261:Pregnancy Trimester, First; D011254:Pregnancy in Diabetics / Q000188:drug therapy / Q000453:epidemiology*; D011295:Prenatal Care / Q000706:statistics & numerical data; D015995:Prevalence
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents