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

Association of diabetes care factors (excluding glycaemic control) with major fetal congenital anomaly in the
offspring of women with type 1 and type 2 diabetes
Diabetes care factor
Cases
n/N (%)
Controls
n/N (%)
Crude OR
[95% CI]
Adjusted OR a
No retinal assessment during
1st trimester or at booking if later 43/111 (39) 49/183 (27) 1.7 [1.0, 2.9] 1.5 [0.9, 2.6]
No referral to ophthalmologist
(if retinopathy present) 4/29 (14) 21/44 (48) 0.2 [0.1, 0.6] 0.1 [0.0, 0.4]
No monitoring for nephropathy 27/118 (23) 26/206 (13) 2.1 [1.1, 3.8] 2.0 [1.1, 3.7]
No test of renal function
(if nephropathy present) 4/12 (33) 5/14 (36) 0.9 [0.2, 4.7] 0.4 [0.1, 3.2]
Assessment of suboptimal diabetes
care during pregnancy 74/113 (65) 112/204 (55) 1.6 [1.0, 2.5] 1.4 [0.9, 2.3]
a
Adjusted for maternal age and deprivation.
Association of maternity care factors with major fetal congenital anomaly in the offspring of women with type 1 and
type 2 diabetes
Maternity care factor
Cases
n/N (%)
Controls
n/N (%)
Crude OR
[95% CI]
Adjusted OR a
Assessment of suboptimal fetal
monitoring (with antenatal evidence
1/13 (8) 1/11 (9) 0.8 [0.0, 16.1] 0.4 [0.0, 8.0]
of growth restricted baby)
Assessment of suboptimal fetal
monitoring (with antenatal evidence
7/20 (35) 27/73 (37) 1.2 [0.4, 3.3] 1.1 [0.3, 3.7]
of fetal size >90th centile)
No discussion of mode and
timing of delivery 6/102 (6) 4/202 (2) 3.1 [0.9, 11.3] 2.5 [0.6, 9.8]
No administration of antenatal
corticosteroids b 12/34 (35) 12/33 (36) 1.0 [0.4, 2.6] 1.0 [0.3, 2.9]
Assessment of suboptimal maternity
care during the antenatal period 57/125 (46) 95/215 (44) 1.1 [0.7, 1.7] 1.1 [0.7, 1.8]
Assessment of suboptimal maternity
care during labour and delivery 44/111 (40) 72/213 (34) 1.3 [0.8, 2.1] 1.3 [0.8, 2.1]
a
Adjusted for maternal age and deprivation.
b
Analysis restricted to babies delivering from 24+0 to 35+6 weeks gestation and excluding antepartum stillbirths.
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