The Journal of clinical endocrinology and metabolism · 2016
Ten Years of Optimizing Outcomes for Women With Type 1 and Type 2 Diabetes in Pregnancy-The Atlantic DIP Experience.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Owens Lisa A, Egan Aoife M, Carmody Louise, Dunne Fidelma
Аннотация
CONTEXT: Pregnancy for women with type 1 or type 2 diabetes is a time of increased risk for both mother and baby. The Atlantic Diabetes in Pregnancy program provides coordinated, evidence-based care for women with diabetes in Ireland. Founded in 2005, the program now shares outcomes over its first decade in caring for pregnant women with diabetes.
OBJECTIVE: The objective was to assess improvements in clinical outcomes after the introduction of interventions.
DESIGN, SETTING, PARTICIPANTS: We retrospectively examined 445 pregnancies in women with type 1 and type 2 diabetes and compared them over two timepoints, 2005–2009 and 2010–2014.
INTEVENTIONS: Interventions introduced over that time include: provision of combined antenatal/diabetes clinics, prepregnancy care, electronic data management, local clinical care guidelines, professional and patient education materials, an app, and a web site.
MAIN OUTCOMES: Pregnancy outcomes were measured.
RESULTS: The introduction of the Atlantic Diabetes in Pregnancy program has been associated with a reduction in adverse neonatal outcomes. There has been a reduction in congenital malformations (5 to 1.8%; P = .04), stillbirths (2.3 vs 0.4%; P = .09), despite an upward trend in maternal age (mean age, 31.7 vs 33 years), obesity (29 vs 43%; body mass index >30 kg/m2), and excessive gestational weight gain (24 vs 38%; P = .002). These improvements in outcomes occur alongside an increase in attendance at prepregnancy care (23 to 49%; P < .001), use of folic acid (45 vs 71%; P < .001), and sustained improvement in glycemic control.
CONCLUSIONS: Changing the process of clinical care delivery and utilizing evidence-based interventions in a pragmatic clinical setting improves pregnancy outcomes for women with pregestational diabetes. We now need to target optimization of maternal body mass index before pregnancy and put a greater focus on gestational weight gain through education and monitoring.
OBJECTIVE: The objective was to assess improvements in clinical outcomes after the introduction of interventions.
DESIGN, SETTING, PARTICIPANTS: We retrospectively examined 445 pregnancies in women with type 1 and type 2 diabetes and compared them over two timepoints, 2005–2009 and 2010–2014.
INTEVENTIONS: Interventions introduced over that time include: provision of combined antenatal/diabetes clinics, prepregnancy care, electronic data management, local clinical care guidelines, professional and patient education materials, an app, and a web site.
MAIN OUTCOMES: Pregnancy outcomes were measured.
RESULTS: The introduction of the Atlantic Diabetes in Pregnancy program has been associated with a reduction in adverse neonatal outcomes. There has been a reduction in congenital malformations (5 to 1.8%; P = .04), stillbirths (2.3 vs 0.4%; P = .09), despite an upward trend in maternal age (mean age, 31.7 vs 33 years), obesity (29 vs 43%; body mass index >30 kg/m2), and excessive gestational weight gain (24 vs 38%; P = .002). These improvements in outcomes occur alongside an increase in attendance at prepregnancy care (23 to 49%; P < .001), use of folic acid (45 vs 71%; P < .001), and sustained improvement in glycemic control.
CONCLUSIONS: Changing the process of clinical care delivery and utilizing evidence-based interventions in a pragmatic clinical setting improves pregnancy outcomes for women with pregestational diabetes. We now need to target optimization of maternal body mass index before pregnancy and put a greater focus on gestational weight gain through education and monitoring.