title: [Pregnancy outcomes in women with pre-existing diabetes].
abstract: OBJECTIVE
  To describe trends in prevalence, indicators of care and pregnancy outcomes for women with pre-existing type I or type II diabetes.
  
  
  METHODS
  Cohort study of all consecutive singleton pregnancies complicated by pre-existing type I or type II diabetes followed from 2004 to 2011 at a tertiary perinatal care centre (n=194). We collected data from the medical records and described trends in demographics, clinical history, indicators of care before or during pregnancy and glycaemic control. We also studied perinatal outcomes, including gestational age at delivery, mode of delivery, and birthweight.
  
  
  RESULTS
  The overall incidence of pregestational diabetes was 4.4 per 1000, with no significant changes throughout the study period. The number of type 2 diabetes cases also remained constant. In 67% of cases delivery occurred after 37 weeks (maximum 80% in 2010 - 11). During this period there was a significant reduction in rates of elective caesarean section (p=0.03) and in the incidence of large infants for gestational age (p=0.04). Indicators of glycaemic control were favorable throughout pregnancy, with no significant trends detected during the study period. However, preconceptional care indicators were substandard, with no significant improvement.
  
  
  CONCLUSIONS
  A multidisciplinary approach to diabetic management and obstetric practice contributed to adequate glycaemic control throughout pregnancy and to improved pregnancy outcomes. Preconceptional care remains a key challenge.
authors.affiliation: Setor de Gestação de Alto Risco do Centro de Atenção à Mulher, Instituto de Medicina Integral Prof Fernando Figueira – IMIP – Recife, PE, Brasil.
authors.forename: Raquel Santos Robalo
authors.initials: RS
authors.lastname: Fernandes
authors.forename: Ana Filipa Bernardino
authors.initials: AF
authors.lastname: Simões
authors.forename: Ana Cristina Neves
authors.initials: AC
authors.lastname: Figueiredo
authors.forename: Ana Rita Silva
authors.initials: AR
authors.lastname: Ribeiro
authors.forename: Francisca Maria Ferreira
authors.initials: FM
authors.lastname: Aleixo
authors.forename: Sílvia Margarida Duarte Teixeira Guerra
authors.initials: SM
authors.lastname: Aragüés
authors.forename: Njila Yakalage Barreira
authors.initials: NY
authors.lastname: Amaral
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011256:Pregnancy Outcome; D011254:Pregnancy in Diabetics / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies