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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Factors associated with poor <strong>pregnancy</strong> outcome<br />
<strong>in</strong> women with type 1 and type 2 diabetes<br />
6.3.4 Glycaemic control<br />
A test of glycaemic control before <strong>pregnancy</strong>, local glycaemic control targets, and panel assessments of<br />
glycaemic control before and dur<strong>in</strong>g <strong>pregnancy</strong>, <strong>we</strong>re exam<strong>in</strong>ed <strong>in</strong> relation to poor <strong>pregnancy</strong> outcome<br />
(table 6.4). A lack of local glycaemic control targets, and suboptimal glycaemic control before and dur<strong>in</strong>g<br />
<strong>pregnancy</strong> <strong>we</strong>re associated with poor <strong>pregnancy</strong> outcome. These issues <strong>are</strong> discussed fur<strong>the</strong>r <strong>in</strong><br />
Chapters 7 and 8.<br />
Table 6.4<br />
Association of factors related to glycaemic control before and dur<strong>in</strong>g <strong>pregnancy</strong> <strong>in</strong> women with type 1 and type 2<br />
diabetes, with poor <strong>pregnancy</strong> outcome<br />
Factor related to glycaemic control<br />
Cases<br />
n/N (%)<br />
Controls<br />
n/N (%)<br />
Crude OR<br />
[95% CI]<br />
Adjusted OR a<br />
[95% CI]<br />
No test of glycaemic control <strong>in</strong> <strong>the</strong><br />
12 months prior to <strong>pregnancy</strong> 36/139 (26) 24/139 (17) 1.7 [0.9, 3.0] 1.5 [0.8, 2.8]<br />
No local targets set for glycaemic control 44/90 (49) 28/86 (33) 2.0 [1.1, 3.7] 2.0 [1.0, 3.8]<br />
Assessment of suboptimal preconception<br />
glycaemic control 165/187 (88) 115/167 (69) 3.4 [1.9, 6.0] 3.9 [2.2, 7.0]<br />
Assessment of suboptimal 1st trimester<br />
glycaemic control 171/204 (84) 118/192 (61) 3.3 [2.0, 5.3] 3.4 [2.1, 5.7]<br />
Assessment of suboptimal glycaemic<br />
control after 1st trimester 146/205 (71) 76/209 (37) 4.3 [2.8, 6.7] 5.2 [3.3, 8.2]<br />
Assessment of suboptimal glycaemic<br />
control dur<strong>in</strong>g labour and delivery 80/162 (49) 96/202 (48) 0.9 [0.6, 1.4] 1.0 [0.7, 1.6]<br />
No <strong>in</strong>travenous <strong>in</strong>sul<strong>in</strong> and dextrose<br />
dur<strong>in</strong>g labour and/or delivery 48/208 (23) 31/217 (14) 1.8 [1.1, 3.0] 1.8 [1.1, 3.0]<br />
a<br />
adjusted for maternal age and deprivation.<br />
6.3.5 Preconception c<strong>are</strong> <strong>in</strong> <strong>the</strong> 12 months prior to <strong>pregnancy</strong><br />
Specifi c preconception c<strong>are</strong> factors, based on <strong>the</strong> medical records held by adult diabetes services<br />
or general practitioners, <strong>we</strong>re <strong>in</strong>vestigated for association with poor <strong>pregnancy</strong> outcome. The results<br />
<strong>are</strong> shown <strong>in</strong> table 6.5 and <strong>are</strong> discussed fur<strong>the</strong>r <strong>in</strong> chapter 8. These fi nd<strong>in</strong>gs <strong>we</strong>re dependent on<br />
documentation <strong>in</strong> <strong>the</strong> medical records, and poor documentation by health professionals of <strong>the</strong> c<strong>are</strong> and<br />
advice given to women may have <strong>in</strong>fl uenced <strong>the</strong> app<strong>are</strong>nt association with poor <strong>pregnancy</strong> outcome.<br />
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