Pregnancy‐related care and outcomes for women with Type 1 diabetes in Scotland

Abstract

PurposeTo assess pregnancy‐related care and outcomes for women with pre‐gestational, Type 1 diabetes.Design/methodology/approachThe study was a prospective, population‐based, clinical audit in Scotland. A total of 273 and 179 pregnancies in two 12‐month audit periods (during 1998/99 and 2003/04 respectively) were examined.FindingsIn both years, antenatal care for women with diabetes was well organised by dedicated multi‐professional teams. Provision of formal pre‐pregnancy clinics increased (1998, four of 22 maternity units; 2003, six of 20 units). Pregnancies documented as “planned” (1998/99, 116/273, or 42.5 per cent; 2003/04, 105/179, or 58.7 per cent; p=0.001) and periconceptual folic acid supplementation, 5 mg daily (1998/99, 40/273, or 14.7 per cent; 2003/04, 71/179, or 39.7 per cent; p<0.0001) increased over time. In both years, women whose pregnancies progressed to delivery attended early for antenatal care (median eight weeks' gestation) and had meticulous monitoring of diabetic control and foetal wellbeing. In the recent year, fewer women had hypoglycaemia during pregnancy (1998/99, 86/212, or 43.9 per cent; 2003/04, 47/160, or 29.4 per cent; p<0.0001). In both years, macrosomia was common (mean z scores: 1.57 in 1998/99 and 1.64 in 2003/04; standard deviations above a reference population mean) and perinatal mortality appeared higher than for the Scottish population (27.9/1,000 in 1998/99 and 24.8/1,000 in 2003/04). There was a (non‐significant) fall in congenital anomaly rate (1998/99: 13/215 births, or 60/1,000; 2003/04, 6/161 births, or 24.8/1,000).Originality/valueRe‐audit after a five‐year interval showed that periconceptual care and pregnancy planning for Scottish women with Type 1 diabetes has improved. Although pregnancy outcomes remain poorer than for the general Scottish population, the apparent reduction in congenital anomalies is encouraging.