Prepregnancy care program improves outcomes, reduces neonatal costs for women with diabetes
Women with diabetes who attended a preconception intervention clinic were more likely to practice better lifestyle habits, have a lower mean HbA1c throughout pregnancy and experience fewer adverse neonatal outcomes, including reduced admissions to neonatal intensive care for offspring, according to recent findings.
In a prospective cohort study, Aoife M. Egan, MB, BCh, BAO, MRCPI, a specialist registrar in diabetes and endocrinology at Galway University Hospitals, Ireland, and colleagues analyzed data from 414 women with type 1 or 2 diabetes participating in the Atlantic-Diabetes in Pregnancy (DIP) initiative. Researchers measured adverse pregnancy outcomes and the difference between program delivery cost and the excess cost of treating adverse outcomes in non-attendees. The cohort attended the prepregnancy program between 2006 and 2014; care included assessment and treatment of diabetes complications and thyroid status, commencement of 5 mg daily folic acid and a focus on intensive glucose monitoring.
Aoife E. Egan
Within the cohort, 149 women (111 with type 1 diabetes; 38 with type 2 diabetes) attended the program. Compared with those who did not participate in the program, attendees were more likely to be older, had longer-duration diabetes, and had a lower mean HbA1c upon entering (7.4% vs. 8.2%).
Attendees were more likely to take preconception folic acid (97.3% vs. 57.7%; P < .001) and were less likely to smoke (8.7% vs. 16.6%; P = .03) or take potentially teratogenic medications at conception (0.7% vs 6%; P = .008). Program attendees also had lower HbA1c levels throughout pregnancy, with a mean first trimester HbA1c of 6.8% vs. 7.7% for non-attendees (P < .001), and a mean third trimester HbA1c of 6.1% vs. 6.5% for non-attendees (P = .001). Offspring of program attendees had a lower rate of serious adverse outcomes (2.4% vs. 10.5%; P = .007).
Researchers found the average adjusted cost of treating adverse pregnancy outcomes was 2,578 euros less for women attending prepregnancy care vs. women receiving standard antenatal care.
“This fully offsets the average cost of prepregnancy care delivery, which is estimated at 449 [euros] per pregnancy — a figure which also takes into consideration the cost of treating those women who attend the program but do not become pregnant,” the researchers wrote. – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.