(Lancet 2017;390:2347–2359) Pregnant women with type 1 diabetes are at increased risk of preeclampsia, cesarean delivery, congenital anomalies, and other adverse pregnancy outcomes. While optimal glycemic control during pregnancy can improve outcomes, it is difficult to accomplish due to the complexity of insulin dose adjustments, changes in insulin sensitivity, and variability of insulin absorption that all occur during pregnancy. Continuous glucose monitoring (CGM) has been successful at improving glycemic control in nonpregnant women but studies in pregnant women have had conflicting results. This study aimed to evaluate the effects of CGM in women with type 1 diabetes who were pregnant or planning to become pregnant.

Objectives Few women with gestational diabetes (GDM) are tested for type 2 diabetes in the postpartum period. Whether women are having physician visits that could be an opportunity to improve testing rates is unknown. This study sought to evaluate population-level trends in postpartum diabetes testing after GDM, and to evaluate postpartum physician care for these women.Design Population-based cohort study.Setting Ontario, Canada.Population Women who delivered between 1994 and 2008.Methods Using population-level healthcare databases, we identified 47 691 women with GDM. They were matched to women without GDM.Main outcome measures An oral glucose tolerance test (OGTT) within 6 months postpartum, the specialty of the physician ordering the test, and ambulatory care visits with physicians from various specialties within 6 months postpartum were recorded.Results Most women with GDM did not receive an OGTT, although testing rates increased slowly over the 14 years of the study, compared with no change in testing for women who had not had GDM. Virtually all women with GDM had postpartum visits with a family physician or obstetrician, but few OGTTs were ordered by physicians from these specialties.Conclusions Despite a slow increase in testing over time and high rates of postpartum visits to family physicians and obstetricians, few women with GDM received the recommended diabetes test. This represents a missed opportunity in a high-risk population. Interventions to change test ordering that target family physicians and obstetricians are most likely to increase the proportion of women with GDM who receive postpartum diabetes testing.

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Background Compared to those without inflammatory bowel disease (IBD), women with IBD may have increased health-care utilization during pregnancy and postpartum. This may lead to significant morbidity and decrease in quality of life. Characterizing this health-care use is important for health-policy purposes to determine methods to shift care to the ambulatory setting. Purpose We aimed to compare health-care utilization of women with and without IBD during preconception, pregnancy and postpartum. Method We accessed administrative databases and validated algorithms at the Institute of Clinical Evaluative Services (ICES) in Ontario to identify women (age 18-55) with and without IBD who had a completed live, singleton pregnancy between 2003 and 2018. The primary outcome was to characterize differences in emergency department (ED) visits and hospitalizations between women with and without IBD during the 12 months preconception, pregnancy, and in the 12 months postpartum. The secondary outcome was to assess differences in prenatal care between women with and without IBD. Multivariable negative binomial regression with generalizing estimating equations, accounting for multiple pregnancies for each patient, was performed to report incidence rate ratios (IRR) with 95% confidence intervals (95% CI). Covariates included maternal age at conception, location of residence at conception (rural vs. urban), socioeconomic status (using surrogate marker of neighborhood income quintile), and maternal comorbidity. Result(s) 9158 pregnancies in 6163 women with IBD and 1,729,411 pregnancies in 1,091,013 women without IBD were included. Women with IBD were older at time of delivery and had greater pre-pregnancy comorbidities. During pregnancy, women with IBD were more likely to visit the ED (IRR 1.13, 95% CI,1.08-1.18) and be hospitalized (IRR 1.11, 95% CI,1.01-1.21) for non-IBD specific reasons. Similarly, during postpartum, women with IBD were more likely to visit the ED (IRR 1.21, 95% CI, 1.15-1.27) and be hospitalized (IRR 1.18, 95% CI, 1.05-1.32) for non-IBD specific reasons. Venous thromboembolic events accounted for 7.0% of all postpartum hospitalizations in women with IBD compared to 2.7% in those without IBD (p<0.0001). There was no difference in ED visits and hospitalizations between women with and without IBD in preconception. Finally, women with IBD had greater number of prenatal visits with obstetricians during pregnancy and were more likely to receive a first trimester prenatal visit compared to those without IBD. Conclusion(s) Compared to those without IBD, women with IBD are more likely to visit the ED and be hospitalized during pregnancy and postpartum, particularly for venous thromboembolic events. Efforts should be made from a health policy perspective to increase access to ambulatory care for patients with IBD during the peripartum period which in turn may reduce acute setting health-services utilization. Please acknowledge all funding agencies by checking the applicable boxes below CCC Disclosure of Interest None Declared