Diabetes in pregnancy: are we providing the best care ... - HQIP

Appendix C
Association of preconception care factors in the 12 months prior to pregnancy with major fetal congenital anomaly in
the offspring of women with type 1 and type 2 diabetes
Preconception care factor
Cases
n/N (%)
Controls
n/N (%)
Crude OR
[95% CI]
Adjusted OR a
No contraceptive advice provided before 16/49 (33) 19/83 (23) 1.6 [0.7, 3.6] 1.6 [0.7, 3.8]
pregnancy
No discussion of the following specifi c
diabetes issues:
Alcohol 15/36 (42) 19/66 (29) 1.8 [0.8, 4.2] 2.2 [0.9, 5.7]
Diet 10/56 (18) 12/100 (12) 1.6 [0.6, 4.0] 1.6 [0.6, 4.2]
Poor glycaemic control 8/66 (12) 14/117 (12) 1.0 [0.4, 2.6] 0.8 [0.3, 2.2]
Retinopathy 11/50 (22) 25/96 (26) 0.8 [0.4, 1.8] 0.6 [0.3, 1.6]
Nephropathy 13/40 (33) 29/76 (38) 0.8 [0.4, 1.8] 0.5 [0.2, 1.4]
Hypertension 12/39 (31) 23/75 (31) 1.0 [0.4, 2.3] 0.6 [0.2, 1.7]
No discussion of the following
pregnancy issues:
Increased diabetes surveillance 5/61 (8) 7/124 (6) 1.5 [0.5, 4.9] 1.4 [0.4, 5.0]
Increased pregnancy surveillance 5/62 (8) 8/124 (6) 1.3 [0.4, 4.1] 1.2 [0.4, 4.0]
Increased risk of induction 10/43 (23) 14/110 (13) 2.1 [0.8, 5.2] 2.3 [0.9, 6.0]
Possible caesarean section 7/49 (14) 11/110 (10) 1.5 [0.5, 4.2] 1.8 [0.6, 5.2]
Fetal risks in diabetic pregnancy 7/52 (13) 7/114 (6) 2.4 [0.8, 7.3] 2.8 [0.8, 9.3]
No dietetic review 24/69 (35) 42/135 (61) 1.2 [0.6, 2.2] 1.2 [0.6, 2.2]
No assessment of the following diabetes
complications in the 12 months prior
to pregnancy:
Baseline retinal examination 19/80 (24) 18/137 (13) 2.1 [1.0, 4.2] 2.0 [0.9, 4.4]
Baseline test of renal function 12/72 (17) 15/133 (11) 1.6 [0.7, 3.6] 1.6 [0.6, 3.9]
Assessment of albuminuria 22/62 (35) 30/109 (28) 1.5 [0.7, 2.8] 1.4 [0.7, 3.0]
Assessment of suboptimal preconception
care (excluding glycaemic control) 68/75 (91) 80/134 (60) 6.6 [2.7, 16.2] 7.0 [2.9, 17.1]
a
Adjusted for maternal age and deprivation.
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