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
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Table 6.2<br />
Association of cl<strong>in</strong>ical characteristics of women with type 1 and type 2 diabetes and <strong>the</strong>ir babies, with poor<br />
<strong>pregnancy</strong> outcome<br />
Cl<strong>in</strong>ical characteristics<br />
Cases<br />
n/N (%)<br />
Controls<br />
n/N (%)<br />
Crude OR<br />
[95% CI]<br />
Adjusted OR a<br />
[95% CI]<br />
Body Mass Index (BMI) ≥30 40/136 (29) 33/137 (24) 1.3 [0.8, 2.3] 1.1 [0.6, 1.9]<br />
Pre-exist<strong>in</strong>g diabetes complications 37/182 (20) 16/197 (8) 2.9 [1.5, 5.5] 2.6 [1.3, 4.9]<br />
Ret<strong>in</strong>opathy <strong>in</strong> <strong>pregnancy</strong> 55/149 (37) 50/167 (30) 1.4 [0.9, 2.2] 1.4 [0.9, 2.4]<br />
Diabetic nephropathy <strong>in</strong> <strong>pregnancy</strong> 28/174 (16) 14/185 (8) 2.3 [1.2, 4.7] 2.0 [1.0, 4.2]<br />
Recurrent episodes of hypoglycaemia 98/195 (50) 105/205 (51) 1.0 [0.7, 1.4] 1.1 [0.7, 1.7]<br />
dur<strong>in</strong>g <strong>pregnancy</strong><br />
Severe hypogylacemia dur<strong>in</strong>g <strong>pregnancy</strong><br />
(one or more episode of hypoglycaemia 31/144 (22) 32/167 (19) 1.2 [0.7, 2.0] 1.3 [0.7, 2.3]<br />
requir<strong>in</strong>g external help)<br />
Antenatal evidence of fetal growth<br />
restriction 26/186 (14) 11/218 (5) 3.1 [1.5, 6.4] 2.9 [1.4, 6.3]<br />
Antenatal evidence of macrosomia<br />
(fetal size >90th centile) 53/179 (30) 76/216 (35) 0.8 [0.5, 1.2] 0.8 [0.5, 1.3]<br />
a<br />
adjusted for maternal age and deprivation.<br />
6.3.3 Social and lifestyle factors<br />
In <strong>the</strong> enquiry, a number of social and lifestyle factors <strong>we</strong>re signifi cantly associated with poor <strong>pregnancy</strong><br />
outcome (table 6.3), and <strong>the</strong>se <strong>are</strong> fur<strong>the</strong>r discussed <strong>in</strong> Chapter 7. There appears to be an urgent need<br />
for fur<strong>the</strong>r research <strong>in</strong>to <strong>the</strong> socio-cultural factors affect<strong>in</strong>g women’s behaviour; education programmes for<br />
women and health professionals; and consideration of how <strong>best</strong> to develop diabetes maternity services.<br />
Table 6.3<br />
Association of social and lifestyle factors <strong>in</strong> women with type 1 and type 2 diabetes with poor <strong>pregnancy</strong> outcome<br />
Social and lifestyle factor<br />
Cases<br />
n/N (%)<br />
Controls<br />
n/N (%)<br />
Crude OR<br />
[95% CI]<br />
Adjusted OR a<br />
[95% CI]<br />
Unplanned <strong>pregnancy</strong> 72/141 (51) 55/144 (38) 1.7 [1.1, 2.7] 1.8 [1.0, 2.9]<br />
No contraceptive use <strong>in</strong> <strong>the</strong> 12 months before<br />
<strong>pregnancy</strong> 71/108 (66) 54/121 (45) 2.4 [1.4, 4.1] 2.3 [1.3, 4.0]<br />
No folic acid commenced prior to <strong>pregnancy</strong> 83/120 (69) 66/131 (50) 2.2 [1.3, 3.8] 2.2 [1.3, 3.9]<br />
Smok<strong>in</strong>g 63/183 (34) 44/182 (24) 1.7 [1.0, 2.6] 1.9 [1.2, 3.2]<br />
Assessment of suboptimal approach<br />
of <strong>the</strong> woman to manag<strong>in</strong>g her diabetes<br />
137/160 (83) 88/154 (57) 4.5 [2.5, 7.9] 4.9 [2.7, 8.8]<br />
before <strong>pregnancy</strong><br />
Assessment of suboptimal approach<br />
of <strong>the</strong> woman to manag<strong>in</strong>g her diabetes<br />
dur<strong>in</strong>g <strong>pregnancy</strong><br />
118/197 (60) 56/207 (27) 4.0 [2.6, 6.3] 3.9 [2.5, 6.1]<br />
a<br />
adjusted for maternal age and deprivation.<br />
27