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

Factors associated with poor pregnancy outcome
in women with type 1 and type 2 diabetes
Table 6.6
Association of diabetes care factors (excluding glycaemic control) in women with type 1 and type 2 diabetes,
with poor pregnancy outcome
Diabetes care factor
Cases
n/N (%)
Controls
n/N (%)
Crude OR
[95% CI]
Adjusted OR a
[95% CI]
No retinal assessment during fi rst trimester
or at booking if later 70/194 (36) 49/183 (27) 1.5 [1.0, 2.4] 1.4 [0.9, 2.2]
No referral to ophthalmologist
(if retinopathy present) 10/45 (22) 21/44 (48) 0.3 [0.1, 0.8] 0.2 [0.1, 0.7]
No monitoring for nephropathy 46/209 (22) 26/206 (13) 2.0 [1.2, 3.3] 1.9 [1.1, 3.3]
No test of renal function
(if nephropathy present) 12/26 (46) 5/14 (36) 1.5 [0.4, 6.0] 1.9 [0.3, 6.0]
Assessment of suboptimal diabetes
care during pregnancy 146/204 (72) 118/204 (58) 1.8 [1.2, 2.8] 1.7 [1.1, 2.6]
a
adjusted for maternal age and deprivation.
6.3.7 Maternity care
The association of maternity care factors with poor pregnancy outcome are shown in table 6.7. It is of
concern that suboptimal maternity care during pregnancy and suboptimal antenatal fetal surveillance of big
babies were associated with poor pregnancy outcome. This, together with issues relating to discussion of
mode and timing of delivery, are discussed further in Chapter 9.
Table 6.7
Association of maternity care factors in women with type 1 and type 2 diabetes with poor pregnancy outcome
Maternity care factor
Cases
n/N (%)
Controls
n/N (%)
Crude OR
[95% CI]
Adjusted OR
[95% CI]
Assessment of suboptimal fetal
monitoring (with antenatal evidence
6/24 (25) 1/11 (9) 3.3 [0.3, 34.1] 2.3 [0.2, 26.3]
of growth restricted baby)
Assessment of suboptimal fetal
monitoring (with antenatal evidence
35/52 (67) 27/73 (37) 3.5 [1.7, 7.4] 5.3 [2.4, 12.0]
of fetal size > 90th centile)
No discussion of mode and timing of delivery 15/178 (8) 4/202 (2) 4.6 [1.5, 14.2] 4.0 [1.2, 12.7]
No administration of antenatal corticosteroids b 14/41 (34) 12/33 (36) 0.9 [0.4, 2.4] 0.9 [0.3, 2.5]
Assessment of suboptimal maternity
care during the antenatal period 125/215 (58) 95/215 (44) 1.8 [1.2, 2.6] 1.9 [1.2, 2.8]
Assessment of suboptimal maternity
care during labour and delivery 78/199 (39) 72/213 (34) 1.3 [0.8, 1.9] 1.3 [0.8, 1.9]
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.
6.3.8 Postnatal care
Although postnatal care factors could not have been causative to poor pregnancy outcome, women who
had a poor pregnancy outcome were more likely to have suboptimal postnatal diabetes care and no
contraceptive advice before discharge from hospital (table 6.8). This is discussed further in Chapter 9.
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