title: ATLANTIC DIP: closing the loop: a change in clinical practice can improve outcomes for women with pregestational diabetes.
abstract: OBJECTIVE
  Prospective evaluation of pregnancy outcomes in women with pregestational diabetes over 6 years.
  
  
  METHODS
  The ATLANTIC Diabetes in Pregnancy group provides care for women with diabetes throughout pregnancy. In 2007, the group identified that women were poorly prepared for pregnancy and outcomes were suboptimal. A change in practice occurred, offering women specialist-led, hub-and-spoke evidence-based care. We now compare outcomes from 2005 to 2007 with those from 2008 to 2010.
  
  
  RESULTS
  There was an increase in the numbers attending preconception care (28-52%, P = 0.01). Glycemic control before and throughout pregnancy improved. There was an overall increase in live births (74-92%, P < 0.001) and decrease in perinatal mortality rate (6.2-0.65%, P < 0.001). There was a decrease in large-for-gestational-age babies in mothers with type 1 diabetes mellitus (30-26%, P = 0.02). Elective caesarean section rates increased, while emergency section rates decreased.
  
  
  CONCLUSIONS
  Changing the process of clinical care delivery can improve outcomes in women with pregestational diabetes.
authors: Department of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland. lisaannowens@gmail.com
authors: Lisa A
authors: LA
authors: Owens
authors: Gloria
authors: G
authors: Avalos
authors: Breda
authors: B
authors: Kirwan
authors: Louise
authors: L
authors: Carmody
authors: Fidelma
authors: F
authors: Dunne
mesh_terms: D005260:Female; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D011254:Pregnancy in Diabetics