An Irish National Diabetes in Pregnancy Audit: aiming for best outcomes for women with diabetes

Diabet Med. 2020 Dec;37(12):2044-2049. doi: 10.1111/dme.13923. Epub 2019 Feb 28.

Abstract

Aims: The purpose of this study was to identify the number of pregnancies affected by pre-gestational diabetes in the Republic of Ireland; to report on pregnancy outcomes and to identify areas for improvement in care delivery and clinical outcomes.

Methods: Healthcare professionals caring for women with pre-gestational diabetes during pregnancy were invited to participate in this retrospective study. Data pertaining to 185 pregnancies in women attending 15 antenatal centres nationally were collected and analysed. Included pregnancies had an estimated date of delivery between 1 January and 31 December 2015.

Results: The cohort consisted of 122 (65.9%) women with Type 1 diabetes and 56 (30.3%) women with Type 2 diabetes. The remaining 7 (3.8%) pregnancies were to women with maturity-onset diabetes of the young (MODY) (n = 6) and post-transplant diabetes (n = 1). Overall women were poorly prepared for pregnancy and lapses in specific areas of service delivery including pre-pregnancy care and retinal screening were identified. The majority of pregnancies 156 (84.3%) resulted in a live birth. A total of 103 (65.5%) women had a caesarean delivery and 58 (36.9%) infants were large for gestational age.

Conclusions: This audit identifies clear areas for improvement in delivery of care for women with diabetes in the Republic of Ireland before and during pregnancy.

MeSH terms

  • Abortion, Spontaneous / epidemiology
  • Adult
  • Aspirin / therapeutic use
  • Cesarean Section
  • Clinical Audit
  • Delivery of Health Care
  • Delivery, Obstetric
  • Diabetes Mellitus, Type 1 / drug therapy*
  • Diabetes Mellitus, Type 1 / metabolism
  • Diabetes Mellitus, Type 2 / metabolism
  • Diabetes Mellitus, Type 2 / therapy*
  • Diabetic Retinopathy / diagnosis
  • Female
  • Fetal Macrosomia / epidemiology
  • Folic Acid / therapeutic use
  • Glycated Hemoglobin / metabolism
  • Humans
  • Hypoglycemic Agents / therapeutic use
  • Infant, Newborn
  • Infusion Pumps, Implantable
  • Insulin / therapeutic use
  • Insulin Infusion Systems
  • Intensive Care Units, Neonatal / statistics & numerical data
  • Ireland / epidemiology
  • Live Birth / epidemiology
  • Mass Screening
  • Metformin / therapeutic use
  • Platelet Aggregation Inhibitors / therapeutic use
  • Preconception Care / statistics & numerical data*
  • Pregnancy
  • Pregnancy Outcome / epidemiology*
  • Pregnancy in Diabetics / therapy*
  • Premature Birth / epidemiology
  • Retrospective Studies
  • Stillbirth / epidemiology
  • Vitamin B Complex / therapeutic use

Substances

  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • Insulin
  • Platelet Aggregation Inhibitors
  • hemoglobin A1c protein, human
  • Vitamin B Complex
  • Metformin
  • Folic Acid
  • Aspirin