Transient Improvement in Glycemic Control: The impact of pregnancy in women with IDDM

Gold, Ann; Reilly, Catherine; Walker, James

doi:10.2337/diacare.21.3.374

Cited by 15 publications

(12 citation statements)

References 12 publications

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“…Sixty-percent of the women (30 of 50) who were controlled during pregnancy had a subsequent uncontrolled HbA1c within 2 years, including all the women who entered pregnancy uncontrolled. Taken together, our findings—that women are able to achieve control when supported and highly motivated during pregnancy, but then trend back toward uncontrolled diabetes due to competing priorities and/or loss to follow-up—echo the conclusions of other studies conducted on pre-existing diabetes in pregnancy [26–28]. …”

Section: Discussionsupporting

confidence: 85%

Glycemic control and healthcare utilization following pregnancy among women with pre-existing diabetes in Navajo Nation

Bachman-Carter

Thorkelson

et al. 2018

BMC Health Serv Res

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BackgroundNative American communities experience greater burden of diabetes than the general population, including high rates of Type 2 diabetes among women of childbearing age. Diabetes in pregnancy is associated with risks to both the mother and offspring, and glycemic control surrounding the pregnancy period is of vital importance.MethodsA retrospective chart review was conducted at a major Navajo Area Indian Health Service (IHS) hospital, tracking women with pre-existing diabetes who became pregnant between 2010 and 2012. Logistic regression was performed to find patient-level predictors of our desired primary outcome—having hemoglobin A1c (HbA1c) consistently < 8% within 2 years after pregnancy. Descriptive statistics were generated for other outcomes, including glycemic control and seeking timely IHS care.ResultsOne hundred twenty-two pregnancies and 114 individuals were identified in the dataset. Baseline HbA1c was the only covariate which predicted our primary outcome (OR = 1.821, 95% CI = 1.184–2.801). Examining glycemic control among pregnancies with complete HbA1c data (n = 59), 59% were controlled before, 85% during, and 34% after pregnancy. While nearly all women received care in the immediate postpartum period, only 49% of women visited a primary care provider and 71% had HbA1c testing in the 2 years after pregnancy.ConclusionsThis is the first analysis of outcomes among women with diabetes in pregnancy in Navajo Nation, the largest reservation and tribal health system in the United States. Our findings demonstrate the positive impact of specialized prenatal care in achieving glycemic control during pregnancy, while highlighting the challenges in maintaining glycemic control and continuity of healthcare after pregnancy.

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Section: Discussionsupporting

confidence: 85%

Glycemic control and healthcare utilization following pregnancy among women with pre-existing diabetes in Navajo Nation

Bachman-Carter

Thorkelson

et al. 2018

BMC Health Serv Res

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“…13 Nevertheless, there is little information about what happens with metabolic control after delivery. A recent study 14 confirmed prior existing data 15 indicating that after birth there is a marked worsening of glycemic control in such patients. This study observed similar weight gain in pregnant patients with diabetes with respect to a nondiabetic population 16 but less weight lost during the first year after delivery.…”

Section: Introductionsupporting

confidence: 60%

“…12---15 This is probably due to the fact that 44.4% of the subjects were treated with CSII prior to gestation and this group of patients often have greater adherence to follow-up. 7,15 Regarding the assessment of the effectiveness of this program, we found that the T1D women included in the PPP had lower HbA1c before pregnancy, which was maintained during the first and third trimesters of pregnancy and one year after delivery, but we failed to prove statistically significant differences in data regarding delivery and newborn outcomes. The limited number of individuals in our study may explain the inability to demonstrate these differences.…”

Section: Discussionmentioning

confidence: 79%

Postpartum metabolic control in a cohort of women with type 1 diabetes

Quirós

Patrascioiu

Perea

et al. 2015

Endocrinología y Nutrición

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“…On the other hand, extensive education programs during pregnancy could help new mothers maintain improved glycemic control after delivery (7). Only one small observational study exists for type 1 diabetes, showing that after a substantial improvement during pregnancy, glycemic control deteriorated, reaching pregestational levels after delivery (8). An urgent need exists for new, up-to-date studies, as the therapeutic aims and tools available 20 years ago have changed dramatically.…”

mentioning

confidence: 99%

Postpregnancy Glycemic Control and Weight Changes in Type 1 Diabetic Women

et al. 2013

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OBJECTIVEPregnancy in type 1 diabetes requires excellent glycemic control. Most pregnant type 1 diabetic women achieve normoglycemia; however, there is scarce data on their postdelivery characteristics. We aimed to examine postpregnancy glycemic control and weight changes in type 1 diabetes.RESEARCH DESIGN AND METHODSWe identified and followed (median 20 months) 254 women with singleton pregnancies receiving postdelivery medical care at a single institution.RESULTSStudy subjects were 28.3 ± 4.7 years of age (mean ± SD), with a diabetes duration of 12.0 ± 7.7 years. Mean A1C before conception was 6.9 ± 1.4%, and preconception weight and BMI were 64.4 ± 10.0 kg and 23.9 ± 3.3 kg/m2, respectively. Mean A1C decreased during pregnancy, reaching 5.7 ± 0.8% in the third trimester. We observed a mean weight gain of 14.4 ± 6.5 kg during pregnancy. Within 6 months after delivery, A1C increased by 0.8% (P < 0.0001) compared with the last trimester, and body weight and BMI were 4.4 kg and 2.5 kg/m2 higher (P < 0.0001) compared with the preconception baseline. A1C further deteriorated by 0.8% until the end of follow-up. For women in the “pregnancy planning” program (n = 117), A1C >12 months after delivery was worse compared with before conception (7.1 vs. 6.5%, P = 0.0018), whereas in women with unplanned pregnancies, it was similar to the pregestational levels (7.3 vs.7.4%, P = 0.59). Weight and BMI in the entire study group did not return to prepregnancy levels and were 2.5 kg (P = 0.0079) and 0.9 kg/m2 higher (P = 0.0058).CONCLUSIONSIn this clinical observation, type 1 diabetic women showed postpregnancy deterioration in glycemic control and were unable to return to prepregnancy weight. Type 1 diabetic women seem to require special attention after delivery to meet therapeutic targets.

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Transient Improvement in Glycemic Control: The impact of pregnancy in women with IDDM

Cited by 15 publications

References 12 publications

Glycemic control and healthcare utilization following pregnancy among women with pre-existing diabetes in Navajo Nation

Glycemic control and healthcare utilization following pregnancy among women with pre-existing diabetes in Navajo Nation

Postpartum metabolic control in a cohort of women with type 1 diabetes

Postpregnancy Glycemic Control and Weight Changes in Type 1 Diabetic Women

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