title: Changing clinical practice can improve clinical outcomes for women with pre-gestational diabetes mellitus.
abstract: Prospective evaluation of pregnancy outcomes in women with pre-gestational diabetes over 6 years. The ATLANTIC Diabetes in Pregnancy group represents 5 antenatal centres along the Irish Atlantic seaboard, providing care for women with diabetes throughout pregnancy. In 2007 the group published a report that recognised that women were poorly prepared for pregnancy and that outcomes were sub-optimal. A change in practice occurred, offering women specialist-led, evidence-based care, both pre-pregnancy and combined antenatal/diabetes clinics during pregnancy. We now compare outcomes from 2005-2007 with 2008-2010. There was an increase in the numbers attending pre-conception care. Glycemic control before and throughout pregnancy improved. There was an overall increase in live births and decrease in perinata mortality rate. There was a decrease in large-for-gestational-age babies in mothers with Type 1 Diabetes. Elective Caesarean section rates increased while emergency section rates decreased. More women had Type 2 diabetes over time and these women were more likely to be obese. Changing the process of clinical care delivery can improve outcomes in for women with pre-gestational diabetes.
authors: School of Medicine National University of Ireland, Galway. lisaannowens@gmail.com
authors: L A
authors: LA
authors: Owens
authors: G
authors: G
authors: Avalos
authors: B
authors: B
authors: Kirwan
authors: L
authors: L
authors: Carmody
authors: F P
authors: FP
authors: Dunne
mesh_terms: D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D002585:Cesarean Section / Q000706:statistics & numerical data; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000628:therapy*; D016640:Diabetes, Gestational / Q000453:epidemiology / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007226:Infant Mortality; D007231:Infant, Newborn; D007494:Ireland / Q000453:epidemiology; D008875:Middle Aged; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000639:trends*; D011446:Prospective Studies
chemical_list: D001786:Blood Glucose