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

Appendix D
Association of diabetes care factors with fetal and neonatal death from 20 weeks gestation in babies 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 43/120 (36) 49/183 (27) 1.5 [0.9, 2.5] 1.4 [0.8, 2.3]
later
No referral to ophthalmologist
(if retinopathy present)
9/26 (35) 21/44 (48) 0.6 [0.2, 1.6] 0.4 [0.1, 1.3]
No monitoring for nephropathy 27/130 (21) 26/206 (13) 1.8 [1.0, 3.3] 1.8 [1.0, 3.2]
No test of renal function (if
nephropathy present)
9/16 (56) 5/14 (36) 2.3 [0.5, 10.7] 2.7 [0.5, 13.8]
Assessment of suboptimal
diabetes care during
pregnancy
90/128 (70) 112/204 (55) 2.0 [1.2, 3.1] 1.8 [1.1, 3.0]
a
adjusted for maternal age and deprivation.
Association of maternity care factors with fetal and neonatal death from 20 weeks gestation in babies of women with
type 1 and type 2 diabetes
Maternity care factor
Assessment of suboptimal
fetal monitoring (with
antenatal evidence of growth
restricted baby)
Assessment of suboptimal
fetal monitoring (with
antenatal evidence of fetal
size >90th centile)
Cases
n/N (%)
Controls
n/N (%)
Crude OR
[95% CI]
Adjusted OR a
6/14 (43) 1/11 (9) 7.5 [0.6, 95.5] 4.4 [0.4, 49.9]
29/33 (88) 27/73 (37) 15.8 [4.0, 61.5] 18.3 [5.6, 59.6]
No discussion of mode and
timing of delivery
11/111 (10) 4/202 (2) 5.45 [1.7, 17.9] 5.0 [1.5, 16.5]
No administration of antenatal
corticosteroids b 6/14 (43) 12/33 (36) 1.3 [0.4, 4.8] 1.1 [0.3, 4.4]
Assessment of suboptimal
maternity care during the 91/132 (69) 95/215 (44) 2.8 [1.8, 4.5] 2.9 [1.8, 4.7]
antenatal period
Assessment of suboptimal
maternity care during labour
and delivery
51/125 (41) 72/213 (34) 1.4 [0.9, 2.1] 1.3 [0.8, 2.2]
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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