Systematic review and meta-analysis of the effectiveness of pre-pregnancy care for women with diabetes for improving maternal and perinatal outcomes

Abstract

Background Pre-gestational diabetes mellitus is associated with increased risk of maternal and perinatal adverse outcomes. This systematic review was conducted to evaluate the effectiveness and safety of pre-conception care (PCC) in improving maternal and perinatal outcomes. Methods Databases from MEDLINE, EMBASE, WEB OF SCIENCE, and Cochrane Library were searched, including the CENTRAL register of controlled trials, and CINHAL up until March 2019, without any language restrictions, for any pre-pregnancy care aiming at health promotion, glycemic control, and screening and treatment of diabetes complications in women with type I or type II pre-gestational diabetes. Trials and observational studies were included in the review. Newcastle-Ottawa scale and the Cochrane collaboration methodology for data synthesis and analysis were used, along with the GRADE tool to evaluate the body of evidence. Results The search identified 8500 potentially relevant citations of which 40 reports of 36 studies were included. The meta-analysis results show that PCC reduced congenital malformations

Diabetes during Pregnancy: A Maternal Disease Complicating the Course of Pregnancy with Long-Term Deleterious Effects on the Offspring. A Clinical Review

“…Yu et al performed a meta-analysis of over 40 million pregnancies from 100 studies and found that type 1 diabetes was associated with an increased risk for neonatal hypoglycemia (OR 26.62) [ 207 ]. Wahabi et al found in 880 diabetic pregnancies that pre-pregnancy care may have little or no effect in reducing the risk of neonatal hypoglycemia (RR 0.93) [ 208 ]. The use of real-time continuous glucose monitoring throughout pregnancy was evaluated among women with Type 1 diabetes from 31 hospitals in Canada, England, Scotland, Spain, Italy, Ireland, and the USA [ 209 ].…”

“…In multiple regression analyses, the risk for macrosomia was significantly increased among women with diabetes type 1 (OR 31.3, p < 0.001); multiparity (OR 6.2, p = 0.003): early pregnancy BMI > 30 kg/m 2 (OR 7.2, p = 0.003); gestational weight gain ≥ 8 kg (OR 3.8, p = 0.047) and living alone (OR 18.4, p = 0.02) [ 210 ]. Wahabi et al, found in a meta-analysis that pre-pregnancy care of diabetic women had little or no effect in reducing macrosomia rate (RR 1.06; nine studies, 2787 women) [ 208 ]. The different definitions of GDM (i.e., the Diabetes and Pregnancy Study Group (IADPSG) criteria versus the National Institute for Health and Care Excellence (NICE) in the U.K criteria) affect the rate of macrosomia.…”

“…The risk of presenting a PI < 10th centile in GDM newborns classified as SGA by customized curves was 4.24 times higher than that of newborns classified as AGA (RR 4.24) [ 213 ]. Wahabi et al found in a meta-analysis that pre-pregnancy care of diabetic women resulted in a large reduction in SGA (RR 0.52; six studies, 2261 women) [ 208 ]. Pre-pregnancy care was associated with improved glycemic control in the first trimester of pregnancy.…”

“…Pre-pregnancy care was associated with improved glycemic control in the first trimester of pregnancy. They hypothesized that the reduction in SGA infants was due to a reduction in congenital malformations and healthy lifestyle promotion, including smoking cessation, weight control, and avoidance of teratogenic drugs [ 208 ].…”

Diabetes and pregnancy

“…In no area of obstetrics does the care of the woman before she conceives have as much impact on the outcomes for her and her baby as in diabetes. We have long known that the degree of diabetes control in the periconception period has a huge influence on the risk of miscarriage, congenital anomalies and stillbirth 3‐5 . The guideline highlights the importance of prepregnancy care, with specific advice provided regarding screening for complications of diabetes including renal, retinal, cardiac, autonomic, autoimmune, nutritional and diabetic foot disease.…”