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Glycemic control may improve with prepregnancy care program

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September 7, 2016

A prepregnancy care program for women with type 1 diabetes may help improve glycemic control without significantly increasing severe hypoglycemic events.

However, program participants may experience some weight gain, according to the researchers.

Irene Vinagre, MD, PhD, of the diabetes unit, endocrinology and nutrition service, Hospital Clinic I Universitari de Barcelona in Spain, and colleagues evaluated 104 women with type 1 diabetes who started a prepregnancy care program from 2011 to 2014 to determine the effect of the program on clinical and metabolic changes.

During the program, participants, who reported plans to become pregnant in the near future, were visited every 4 to 8 weeks by a consultant physician and diabetes specialist nurse and were counseled to self-monitor blood glucose before and 1 hour after meals, at bedtime and occasionally at night. Self-management skills were also reinforced. Participants who had HbA1c levels less than 6.5% on two consecutive visits — or less than 7% if they had repeated episodes of severe hypoglycemia or impaired awareness of hypoglycemic — were advised to proceed with pregnancy attempts. Follow-up was conducted until participants became pregnant or dropped out.

The prepregnancy program had a median duration of 14.2 months. Metabolic control improved in all participants (P < .001), with 71% reaching HbA1c less than 7% and half less than 6.5% at the end of the program.

The HbA1c target of less than 6.5% was reached by 65.4% of participants, and these women also obtained medical professional recommendation for pregnancy within a median 5.4 months. Recommendations for pregnancy were predicted by lower baseline HbA1c and fewer previous pregnancies.

Researchers observed no significant change in insulin requirements, but the program was associated with weight gain (P = .003). After adjustment for age, baseline BMI, increase of insulin dose, episodes of severe hypoglycemia and dropout, weight gain was independently related with a greater decrease in HbA1c (P = .047) and longer duration in the program (P = .002).

During the program there were 15 severe hypoglycemic events.

Among program participants, 31 dropped out. The most common reasons for discontinuing were infertility (36.4%), family problems (36.4%), unexplained cessation of follow-up (18.2%), a concomitant illness (6.1%) and failure to achieve glycemic target (3%).

Pregnancy occurred in 71 participants, of which 21 pregnancies were without medical professional recommendation and in women with a mean HbA1c of 7.5%. Miscarriage or any early termination occurred in 18 of the pregnancies, and there were 53 deliveries.

“Our [prepregnancy care program] was associated with an improvement in glycemic control without a significant increase in [severe hypoglycemia] events, although with some weight gain,” the researchers wrote. “Unfortunately, a considerable number of patients dropped out during follow-up, this being related to an older age and a longer duration of the program. This information could be of help to design new and more effective [prepregnancy care program] approaches.” – by Amber Cox

Disclosure: The researchers report no relevant financial disclosures.