title: Care of women with diabetes before, during and after pregnancy: time for a new approach?
abstract: This study assesses the impact of pregnancy and pre-pregnancy care on longer-term treatment goals in women with diabetes.
  
  
  
  This retrospective study included women with Type 1 (n = 247) and Type 2 diabetes (n = 137) who were evaluated before, during and after pregnancy.
  
  
  
  Among women with Type 1 diabetes, average HbA1cat 12 months post-partum was similar to the preconception level [63 vs. 64 mmol/mol (7.9% vs. 8.0%), P = 0.60]. This was also the case for women with Type 2 diabetes [52 vs. 52 mmol/mol (6.9% vs. 6.9%), P = 0.79]. At 12 months post-partum, there was no improvement in other measures of diabetes control and one in five women are lost to follow-up from clinical care. In total, 44.9% of women with Type 1 diabetes and 27.7% of those with Type 2 diabetes attended pre-pregnancy care. Attendees maintained superior glycaemic control throughout the study and were more likely to be receiving specialist care post-partum.
  
  
  
  These findings identify a need to change our approach to the reproductive care of women with diabetes. In particular, efforts should be made to ensure all women have access to and attend pre-pregnancy care, and barriers to engagement with post-partum care should be addressed.
authors.affiliation: Galway Diabetes Research Centre, National University of Ireland Galway, Galway, Ireland.
authors.forename: A M
authors.identifier: 0000-0003-0379-9279
authors.initials: AM
authors.lastname: Egan
authors.affiliation: Galway Diabetes Research Centre, National University of Ireland Galway, Galway, Ireland.
authors.forename: L
authors.initials: L
authors.lastname: Carmody
authors.affiliation: Galway Diabetes Research Centre, National University of Ireland Galway, Galway, Ireland.
authors.forename: B
authors.initials: B
authors.lastname: Kirwan
authors.affiliation: Galway Diabetes Research Centre, National University of Ireland Galway, Galway, Ireland.
authors.forename: F P
authors.initials: FP
authors.lastname: Dunne
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D010358:Patient Participation / Q000706:statistics & numerical data; D011181:Postnatal Care / Q000379:methods / Q000639:trends; D049590:Postpartum Period; D016742:Preconception Care / Q000379:methods / Q000639:trends; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000097:blood / Q000628:therapy*; D011295:Prenatal Care / Q000379:methods / Q000639:trends; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human