Development of an integrated, district-wide approach to pre-pregnancy management for women with pre-existing diabetes in a multi-ethnic population

Sina, Maryam; MacMillan, Freya; Dune, Tinashe; Balasuriya, Navodya; Khouri, Nouran; Nguyen, Ngan Thi Kim; Jongvisal, Vasyngpong; Lay, Xiang Hui; Simmons, David

doi:10.1186/s12884-018-2028-2

Cited by 14 publications

(9 citation statements)

References 43 publications

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“…Higher levels of prepregnancy physical activity are associated with a significant reduction in the risk of gestational diabetes (odds ratio [OR]: 0.45, 95% CI: 0.28-0.75),10 underscoring the importance of weight management in interpregnancy care. Other preconception interventions in diabetics, including educational programs, clinic visits, or counseling, have been associated with a sustained reduction in hemoglobin A 1c values, significant reduction in the rate of adverse pregnancy outcomes, reduction in maternal smoking, and increased maternal contraception and folic acid use 11. These data support the role of interpregnancy care in improving maternal health outcomes; however, these studies did not evaluate long-term health benefits of these interventions.…”

Section: Diabetesmentioning

confidence: 96%

Interpregnancy Care: An Opportunity to Improve Women's Health and Reduce the Risk of Maternal Morbidity and Mortality

Erondu

Dunlop

2021

Journal of Public Health Management and Practice

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Interpregnancy care is the health care provided to a woman during the postpartum and preconception periods between pregnancies. Half of maternal deaths occur postpartum and cardiometabolic complications of pregnancy increase the risk for maternal morbidity and mortality and development of chronic conditions. By improving women's health between and beyond pregnancies, interpregnancy care has the potential to improve pregnancy outcomes and women's long-term health. This practice brief report summarizes evidence regarding the impact of interpregnancy care on pregnancy and long-term health outcomes for women with hypertension, diabetes, substance use, and mental health disorders. Existing evidence is limited but demonstrates that the utilization of interventions during this period may result in improved health outcomes. Additional research efforts are needed to better understand the impact of interpregnancy care on women's health throughout the life course.

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Section: Diabetesmentioning

confidence: 96%

Interpregnancy Care: An Opportunity to Improve Women's Health and Reduce the Risk of Maternal Morbidity and Mortality

Erondu

Dunlop

2021

Journal of Public Health Management and Practice

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“…Pregnancies complicated by type 2 diabetes often have comparable rates of congenital malformations, stillbirths, and other adverse pregnancy outcomes (9), requiring the same degree of obstetric monitoring (and intervention) as pregnancies complicated by type 1 diabetes. There are also additional risks from fetal exposure to potentially harmful antihyperglycemic agents, along with a greater prevalence of actually or potentially teratogenic pharmacological agents to manage components of the metabolic syndrome (e.g., antihypertensives and antilipid agents) (11). There are maternal threats from the progression of retinopathy, nephropathy, and cardiovascular disease.…”

mentioning

confidence: 99%

Paradigm Shifts in the Management of Diabetes in Pregnancy: The Importance of Type 2 Diabetes and Early Hyperglycemia in Pregnancy

Simmons

2020

Diabetes Care

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For over 50 years, the diagnosis of gestational diabetes mellitus (GDM) has been based upon an oral glucose tolerance test at 24-28 weeks' gestation. This is the time during pregnancy when insulin resistance is increasing and hyperglycemia develops among those with insufficient insulin secretory capacity to maintain euglycemia. The Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study and the two major randomized controlled trials of treating GDM are based upon recruitment of women at this time during pregnancy. Meanwhile, the increasing prevalence of type 2 diabetes in pregnancy, with its significant risk of adverse pregnancy outcomes, has led to a need to identify undiagnosed diabetes as near to conception as possible. Screening for undiagnosed diabetes early in pregnancy also identifies women with hyperglycemia less than overt diabetes, yet at increased risk of adverse pregnancy outcomes. Such women are more insulin resistant-with higher blood pressure, triglycerides, perinatal mortality, and neonatal hypoglycemia with a greater need for insulin treatment-than those with GDM diagnosed at 24-28 weeks' gestation. Currently, there is uncertainty over how to diagnose GDM early in pregnancy and the benefits and harms from using the current management regimen. Randomized controlled trials testing the criteria for, and treatment of, GDM early in pregnancy are urgently needed to address this existing equipoise. In the meantime, the importance of early or "prevalent GDM" (i.e., mild hyperglycemia present from early [before] pregnancy) warrants interim criteria and thresholds for medication, which may differ from those in use for GDM diagnosed at 24-28 weeks' gestation.For over 50 years, the diagnosis of gestational diabetes mellitus (GDM) has been based upon an oral glucose tolerance test (OGTT) at 24-28 weeks' gestation (1). This time in gestation is when insulin resistance is increasing with the development of hyperglycemia among those with insufficient insulin secretory capacity to maintain euglycemia (2). In Freinkel's iconic Banting Lecture in 1980, building upon the Pederson hypothesis (3, 4), hyperglycemia was described as causing short-and long-term harm to the growing fetus through "fuel-mediated teratogenesis" (5). Different time-dependent impacts of hyperglycemia on the fetus, shown in Fig. 1,

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“…Therefore there is a need for targeted interventions to upskill health professionals on diabetes in pregnancy, and critically in primary care. A multifaceted approach with programs for women with diabetes and health professionals has been shown to be beneficial for increased contraception uptake and reduced adverse pregnancy outcomes 21 . Therefore and in response to the survey findings, NDSS resources have been developed for women with diabetes, including a pregnancy and diabetes website (http://ndss.com.au/pregnancy), a dedicated pregnancy and diabetes e‐newsletter and a pregnancy planning checklist 22 .…”

Section: Discussionmentioning

confidence: 99%

Women with type 1 diabetes and women with type 2 diabetes differ in knowledge and beliefs about contraception and pregnancy

et al. 2021

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Aims To assess differences in knowledge and beliefs about pregnancy in women with diabetes. Methods Questions were from the Australian ‘Contraception, Pregnancy & Women's Health’ survey. Women (18–50 years) were eligible if pregnant or planning pregnancy. Knowledge and beliefs items were adapted from the Reproductive Health and Behaviours Questionnaire. Results Compared to women with type 2 diabetes (n = 103), women with type 1 diabetes (n = 526) had higher scores for knowledge about pregnancy in diabetes (type 1 diabetes 9.8 ± 2.4 vs. type 2 diabetes 7.7 ± 3.1), beliefs about benefits (type 1 diabetes 18.4 ± 2.2 vs. type 2 diabetes 17.2 ± 3.3), cues‐to‐action (type 1 diabetes 2.7 ± 1.4 vs. type 2 diabetes 1.5 ± 1.3) and self‐efficacy (type 1 diabetes 22.6 ± 5.5 vs. type 2 diabetes 20.2 ± 6.1 (all p < 0.001) regarding preparing for pregnancy. Major knowledge gaps were the need for higher dose folate compared to women without diabetes and uncertainty about breastfeeding recommendations. Women with type 1 diabetes believed more strongly in the benefits of ‘close to target’ glucose levels prior to pregnancy and using contraception to prevent unplanned pregnancy; they also felt more confident to access pre‐pregnancy care and to wait for optimal glycaemia before pregnancy. Women with type 2 diabetes were less aware of contraceptive choices, and risks associated with hyperglycaemia before or early in pregnancy. Conclusions The findings highlighted main gaps in knowledge and beliefs about planning for pregnancy. Especially in type 2 diabetes, there is a need for evidence‐based messaging and strategies addressing these gaps, to raise understanding to prepare for future pregnancies.

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Development of an integrated, district-wide approach to pre-pregnancy management for women with pre-existing diabetes in a multi-ethnic population

Cited by 14 publications

References 43 publications

Interpregnancy Care: An Opportunity to Improve Women's Health and Reduce the Risk of Maternal Morbidity and Mortality

Interpregnancy Care: An Opportunity to Improve Women's Health and Reduce the Risk of Maternal Morbidity and Mortality

Paradigm Shifts in the Management of Diabetes in Pregnancy: The Importance of Type 2 Diabetes and Early Hyperglycemia in Pregnancy

Women with type 1 diabetes and women with type 2 diabetes differ in knowledge and beliefs about contraception and pregnancy

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