OBJECTIVE -The objective of this study was to examine the relationship between prepregnancy care, glycemic control, maternal hypoglycemia, and pregnancy outcomes in women with type 1 diabetes.RESEARCH DESIGN AND METHODS -This was a prospective observational cohort study of women with type 1 diabetes who delivered from 1991 to 2002. Outcome measures were attendance at a clinic for prepregnancy care, maternal HbA 1c (A1C) throughout pregnancy, maternal severe hypoglycemic episodes, macrosomia, preeclampsia, premature delivery (delivery before 37 weeks), very premature delivery (delivery before 34 weeks), spontaneous abortion, and adverse pregnancy outcome (defined as major malformation, stillbirth, and neonatal death).RESULTS -There were 290 pregnancies, in which 110 (38%) women had prepregnancy care. The prepregnancy care group contained more primiparous women (54.7 vs. 40.6%; P ϭ 0.021) and fewer smokers (9.4 vs. 28.7%; P Ͻ 0.0001). They registered earlier (6.6 vs. 8.3 weeks, P Ͻ 0.0001) and had a lower A1C at the initial visit (6.5% vs. 7.6%; P Ͻ 0.0001). Adverse pregnancy outcomes and very premature deliveries were significantly lower in women who received prepregnancy care (2.9 vs. 10.2%; P ϭ 0.03 and 5.0 vs. 14.2%; P ϭ 0.02, respectively). In contrast, between groups, there was no difference in A1C after 24 weeks or in the rates of macrosomia, preeclampsia, or maternal severe hypoglycemic episodes.CONCLUSIONS -Prepregnancy care was associated with improved glycemic control in early pregnancy and significant reductions in adverse pregnancy outcome (malformation, stillbirth, and neonatal death) and very premature delivery. However, prepregnancy care failed to have an impact on glycemic control in later pregnancy or to reduce the risk of macrosomia and preeclampsia. Diabetes Care 29:1744 -1749, 2006D iabetes is the most common medical condition to complicate pregnancy, affecting 1 pregnant woman in 250 in the U.K. (1). Women with type 1 diabetes have a poor outcome compared with women without diabetes, with increased rates of congenital malformations, preeclampsia, premature delivery, perinatal mortality, and risk of delivering a macrosomic baby (2). The Confidential Enquiry into Maternal and Child Health (CEMACH) confirms a nearly fourfold rise in perinatal mortality rates and twofold rise in congenital malformation rate in women with diabetes over baseline rates in England, Wales, and Northern Ireland (1). Studies suggest that the risk of adverse outcome (malformation and perinatal mortality) is related to poor glycemic control in early pregnancy (3,4). The critical time period for optimal glycemic control is before 7 weeks' gestation, during early organogenesis (5). Prepregnancy care is the only intervention that targets glycemic control at this critical early stage and has been associated with improvements in maternal and perinatal outcomes (4,6 -13). The association of prepregnancy care with reduced risk of major congenital malformation has been further confirmed on meta-analysis (14). Some studies of macr...

The aim of this study was to examine the influence of prepregnancy care and its effect on early glycaemic control and also the effect of glycaemic control in later pregnancy on risk of preeclampsia in women with type I diabetes. A prospective cohort study of 290 consecutive nonselected pregnancies in women with type I diabetes was performed from 1991 to 2002. We examined the relationship of monthly glycosylated haemoglobin (HbA1c) level, pre-pregnancy care, parity, diabetes duration, microvascular complications, maternal age, weight and smoking with risk of pre-eclampsia. Pre-eclampsia developed in 31/243 singleton births (12.8%). HbA1c level at 24 weeks was significantly increased in women with pre-eclampsia compared with women without preeclampsia (6.0 versus 5.6%, P = 0.017) and was, after nulliparity, the strongest independent predictor of increased risk (OR 1.65 for each 1% increase in HbA1c; P = 0.01). In contrast, there was no relationship between pre-pregnancy care or HbA1c level at booking and risk of pre-eclampsia.