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

Appendix E
Association between preconception care factors in the 12 months prior to pregnancy of fetal and neonatal deaths
(excluding major fetal congenital anomaly) from 20 weeks gestation in babies 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 pregnancy
12/36 (33) 19/83 (23) 1.7 [0.7, 4.0] 1.6 [0.7, 3.8]
No discussion of the
following specifi c diabetes
issues:
Alcohol 16/34 (47) 19/66 (29) 2.2 [0.9, 5.3] 2.7 [1.1, 6.9]
Diet 10/47 (21) 12/100 (12) 2.0 [0.8, 5.0] 2.1 [0.8, 5.4]
Poor glycaemic control 10/52 (19) 14/117 (12) 1.8 [0.7, 4.3] 1.6 [0.7, 4.0]
Retinopathy 14/33 (42) 25/96 (26) 2.1 [0.9, 4.9] 2.0 [0.8, 4.7]
Nephropathy 15/34 (44) 29/76 (38) 1.3 [0.6, 2.9] 1.2 [0.5, 2.8]
Hypertension 15/32 (47) 23/75 (31) 2.0 [0.8, 4.7] 1.7 [0.7, 4.3]
No discussion of the
following pregnancy issues:
Increased diabetes
surveillance
8/62 (13) 7/124 (6) 2.5 [0.8, 7.3] 2.3 [0.8, 6.8]
Increased pregnancy
surveillance
8/55 (15) 8/124 (6) 2.5 [0.9, 7.0] 2.2 [0.8, 6.5]
Increased risk of induction 11/40 (28) 14/110 (13) 2.6 [1.1, 6.5] 2.3 [0.9, 6.2]
Possible caesarean section 13/46 (28) 11/110 (10) 3.6 [1.4, 8.9] 3.7 [1.4, 10.2]
Fetal risks in diabetic
pregnancy
10/46 (22) 7/114 (6) 4.3 [1.5, 12.4] 3.6 [1.1, 11.6]
No dietetic review 22/60 (37) 42/135 (61) 1.3 [0.7, 2.4] 1.3 [0.6, 2.5]
No assessment of
the following diabetes
complications in the 12
months prior to pregnancy:
Baseline retinal
examination
17/61 (28) 18/137 (13) 2.6 [1.2, 5.5] 2.6 [1.2, 5.9]
Baseline test of
renal function
14/58 (24) 15/133 (11) 2.5 [1.1, 5.7] 2.6 [1.1, 6.3]
Assessment of albuminuria 19/54 (35) 30/109 (28) 1.4 [0.7, 2.9] 1.6 [0.8, 3.3]
Assessment of suboptimal
preconception care
(excluding glycaemic
control)
48/58 (83) 80/134 (60) 3.2 [1.5, 7.1] 4.0 [0.7, 9.4]
a
Adjusted for maternal age and deprivation.
132