Diabetes in pregnancy: are we providing the best care ... - HQIP
Diabetes in pregnancy: are we providing the best care ... - HQIP Diabetes in pregnancy: are we providing the best care ... - HQIP
Appendix C Association between demographic and clinical characteristics, social and lifestyle factors, and clinical care with major fetal congenital anomaly in the offspring of women with type 1 and type 2 diabetes Association of demographic characteristics with major fetal congenital anomaly in the offspring of women with type 1 and type 2 diabetes Demographic characteristic Cases n/N (%) Controls n/N (%) Crude OR [95% CI] Adjusted OR Age - - 1.0 [1.0, 1.1] 1.0 [1.0, 1.1] b Black, Asian or Other Ethnic Minority group 22/127 (17) 41/220 (19) 0.9 [0.5, 1.6] 0.6 [0.3, 1.2] a Primigravidity 52/127 (41) 92/220 (42) 1.0 [0.6, 1.5] 1.1 [0.7, 1.8] a Maternal social deprivation d - - 1.2 [1.0, 1.4] 1.2 [1.0, 1.4] c a adjusted for maternal age and deprivation. b adjusted for maternal deprivation. c adjusted for maternal age. Odds ratio is for one year increase in maternal age. d Quintile of social deprivation derived from postcode of residence. Odds ratio is for unit increase in deprivation quintile. Association of clinical characteristics with major fetal congenital anomaly in the offspring of women with type 1 and type 2 diabetes Clinical characteristic Cases n/N (%) Controls n/N (%) Crude OR [95% CI] Adjusted OR a Body Mass Index (BMI ≥ 30) 53/80 (66) 33/137 (24) 1.6 [0.9, 3.0] 1.3 [0.7, 2.5] Pre-existing diabetes complications 22/104 (21) 16/197 (8) 3.0 [1.5, 6.2] 3.1 [1.5, 6.3] Retinopathy in pregnancy 34/88 (39) 50/167 (30) 1.5 [0.9, 2.5] 1.5 [0.9, 2.7] Diabetic nephropathy in pregnancy 14/103 (13) 14/185 (8) 1.9 [0.9, 4.2] 1.7 [0.7, 3.9] Recurrent episodes of hypoglycaemia during pregnancy 56/109 (51) 105/205 (51) 1.0 [0.6, 1.6] 1.1 [0.6, 1.8] Severe hypoglycaemia during pregnancy (one or more episodes of hypoglycaemia 18/78 (23) 32/167 (19) 1.3 [0.7, 2.4] 1.4 [0.7, 2.8] requiring external help) Antenatal evidence of fetal growth restriction 15/105 (14) 11/218 (5) 3.1 [1.4, 7.2] 3.0 [1.2, 7.0] Antenatal evidence of macrosomia (fetal size >90th centile) 21/100 (21) 76/216 (35) 0.5 [0.3, 0.9] 0.5 [0.3, 0.9] a adjusted for maternal age and deprivation. 120
Association of social and lifestyle factors with major fetal congenital anomaly in the offspring of women with type 1 and type 2 diabetes Social and lifestyle factor Cases n/N (%) Controls n/N (%) Crude OR [95% CI] Adjusted OR a Unplanned pregnancy 43/75 (57) 55/144 (38) 2.2 [1.2, 3.9] 2.3 [1.3, 4.3] No contraceptive use in the 12 months before pregnancy 33/55 (60) 54/121 (45) 1.9 [1.0, 3.6] 2.0 [1.0, 4.0] No folic acid commenced prior to pregnancy 49/69 (71) 66/131 (50) 2.4 [1.3, 4.6] 2.3 [1.2, 4.5] Smoking 35/103 (34) 44/182 (24) 1.6 [1.0, 2.8] 2.2 [1.2, 3.9] Assessment of suboptimal approach of the woman to managing her diabetes 80/92 (86) 88/154 (57) 4.6 [2.3, 9.3] 5.0 [2.4, 10.2] before pregnancy Assessment of suboptimal approach of the woman to managing her diabetes during pregnancy 62/110 (56) 56/207 (27) 3.5 [2.1, 5.8] 3.5 [2.0, 5.9] a Adjusted for maternal age and deprivation. Association of glycaemic control factors before and during pregnancy with major fetal congenital anomaly in the offspring of women with type 1 and type 2 diabetes Glycaemic control factor Cases n/N (%) Controls n/N (%) Crude OR [95% CI] Adjusted OR a No test of glycaemic control 18/76 (24) 24/139 (17) 1.5 [0.7, 3.0] 1.2 [0.6, 2.6] before pregnancy No local targets set for glycaemic control 20/43 (47) 28/86 (33) 1.8 [0.8, 3.9] 1.8 [0.8, 4.1] Assessment of suboptimal preconception glycaemic control 96/111 (86) 115/167 (69) 2.9 [1.5, 5.5] 3.6 [1.8, 7.2] Assessment of suboptimal 1st trimester glycaemic control 94/115 (82) 118/192 (61) 2.8 [1.6, 4.0] 3.3 [1.8, 6.0] Assessment of suboptimal glycaemic control after 1st trimester 78/112 (70) 76/209 (37) 4.0 [2.4, 6.8] 5.5 [3.2, 9.6] Assessment of suboptimal blood glucose control during labour and delivery 38/92 (41) 94/202 (47) 0.8 [0.5, 1.3] 0.9 [0.5, 1.5] No intravenous insulin and dextrose during labour and/or delivery 27/115 (23) 31/127 (14) 1.8 [1.0, 3.3] 1.8 [1.0, 3.3] a Adjusted for maternal age and deprivation. 121
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Appendix C<br />
Association bet<strong>we</strong>en demographic and cl<strong>in</strong>ical characteristics, social and lifestyle factors, and cl<strong>in</strong>ical c<strong>are</strong><br />
with major fetal congenital anomaly <strong>in</strong> <strong>the</strong> offspr<strong>in</strong>g of women with type 1 and type 2 diabetes<br />
Association of demographic characteristics with major fetal congenital anomaly <strong>in</strong> <strong>the</strong> offspr<strong>in</strong>g of women<br />
with type 1 and type 2 diabetes<br />
Demographic characteristic<br />
Cases<br />
n/N (%)<br />
Controls<br />
n/N (%)<br />
Crude OR [95%<br />
CI]<br />
Adjusted OR<br />
Age - - 1.0 [1.0, 1.1] 1.0 [1.0, 1.1] b<br />
Black, Asian or O<strong>the</strong>r Ethnic<br />
M<strong>in</strong>ority group 22/127 (17) 41/220 (19) 0.9 [0.5, 1.6] 0.6 [0.3, 1.2] a<br />
Primigravidity 52/127 (41) 92/220 (42) 1.0 [0.6, 1.5] 1.1 [0.7, 1.8] a<br />
Maternal social deprivation d - - 1.2 [1.0, 1.4] 1.2 [1.0, 1.4] c<br />
a<br />
adjusted for maternal age and deprivation.<br />
b<br />
adjusted for maternal deprivation.<br />
c<br />
adjusted for maternal age. Odds ratio is for one year <strong>in</strong>crease <strong>in</strong> maternal age.<br />
d<br />
Qu<strong>in</strong>tile of social deprivation derived from postcode of residence. Odds ratio is for unit <strong>in</strong>crease <strong>in</strong> deprivation qu<strong>in</strong>tile.<br />
Association of cl<strong>in</strong>ical characteristics with major fetal congenital anomaly <strong>in</strong> <strong>the</strong> offspr<strong>in</strong>g of women with<br />
type 1 and type 2 diabetes<br />
Cl<strong>in</strong>ical characteristic<br />
Cases<br />
n/N (%)<br />
Controls<br />
n/N (%)<br />
Crude OR<br />
[95% CI]<br />
Adjusted OR a<br />
Body Mass Index (BMI ≥ 30) 53/80 (66) 33/137 (24) 1.6 [0.9, 3.0] 1.3 [0.7, 2.5]<br />
Pre-exist<strong>in</strong>g diabetes complications 22/104 (21) 16/197 (8) 3.0 [1.5, 6.2] 3.1 [1.5, 6.3]<br />
Ret<strong>in</strong>opathy <strong>in</strong> <strong>pregnancy</strong> 34/88 (39) 50/167 (30) 1.5 [0.9, 2.5] 1.5 [0.9, 2.7]<br />
Diabetic nephropathy <strong>in</strong> <strong>pregnancy</strong> 14/103 (13) 14/185 (8) 1.9 [0.9, 4.2] 1.7 [0.7, 3.9]<br />
Recurrent episodes of<br />
hypoglycaemia dur<strong>in</strong>g <strong>pregnancy</strong> 56/109 (51) 105/205 (51) 1.0 [0.6, 1.6] 1.1 [0.6, 1.8]<br />
Severe hypoglycaemia dur<strong>in</strong>g <strong>pregnancy</strong><br />
(one or more episodes of hypoglycaemia 18/78 (23) 32/167 (19) 1.3 [0.7, 2.4] 1.4 [0.7, 2.8]<br />
requir<strong>in</strong>g external help)<br />
Antenatal evidence of fetal<br />
growth restriction 15/105 (14) 11/218 (5) 3.1 [1.4, 7.2] 3.0 [1.2, 7.0]<br />
Antenatal evidence of macrosomia<br />
(fetal size >90th centile) 21/100 (21) 76/216 (35) 0.5 [0.3, 0.9] 0.5 [0.3, 0.9]<br />
a<br />
adjusted for maternal age and deprivation.<br />
120
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