title: Type-2 diabetes mellitus: does prenatal care affect outcomes?
abstract: OBJECTIVE
  To determine if prenatal care affects adverse perinatal outcomes in pregnant women with Type-2 diabetes mellitus (T2DM).
  
  
  METHODS
  This was a retrospective cohort study of pregnant women with pregestational diabetes mellitus pregnancies in the state of California between 1997 and 2006, using vital statistics data linked to birth certificates. Women were stratified by time of presentation to care and we compared those who presented in the first trimester, third trimester, and those who had no prenatal care prior to delivery. Perinatal outcomes looked at included: preeclampsia, macrosomia, preterm delivery, cesarean delivery, and intrauterine fetal demise (IUFD). The two groups were compared with chi-squared testing to determine statistical significance.
  
  
  RESULTS
  In women with pregestational diabetes those who presented at time of delivery had an 11.3% risk of IUFD compared to 0.9% in those who presented in the first trimester. There was also an increased rate of preterm birth in the late presentation cohort (29.4% at time of delivery versus 21.0% in the first trimester). After adjusting for possible confounding variables using logistic regression models, rates of IUFD and preterm delivery were still found to be statistically significant with adjusted odds ratios of 11.37 (95% CI: 6.10-21.16) and 1.55 (95% CI: 1.03-2.32), respectively. There were no differences in rates of macrosomia or preeclampsia between the three cohorts.
  
  
  CONCLUSIONS
  Treatment of T2DM throughout pregnancy leads to improved maternal and neonatal outcomes.
authors.affiliation: a Department of Obstetrics and Gynecology , Oregon Health and Science University , OR , USA.
authors.forename: Allison J
authors.initials: AJ
authors.lastname: Allen
authors.affiliation: a Department of Obstetrics and Gynecology , Oregon Health and Science University , OR , USA.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Snowden
authors.affiliation: a Department of Obstetrics and Gynecology , Oregon Health and Science University , OR , USA.
authors.forename: Bernard
authors.initials: B
authors.lastname: Lau
authors.affiliation: b Department of Obstetrics and Gynecology , California Pacific Medical Center , CA , USA.|c Department of Surgery , University of California Davis , CA , USA.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Cheng
authors.affiliation: a Department of Obstetrics and Gynecology , Oregon Health and Science University , OR , USA.
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Caughey
mesh_terms: D000328:Adult; D002140:California / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D011254:Pregnancy in Diabetics / Q000453:epidemiology*; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies
keywords: T2DM; pregnancy; prenatal care