Introduction

Pre-gestational diabetes is associated with an increased incidence of adverse maternal and infant outcomes. Pre-pregnancy planning has been shown to improve pregnancy outcomes. This study aims to determine whether early review of women with pre-gestational diabetes (but without pre-pregnancy planning) for management leads to significantly better maternal and neonatal outcomes.

Methods

This study was a retrospective audit of pregnant women with Type 1 or Type 2 diabetes referred to the Diabetes Service at Liverpool Hospital for antenatal management from July 2017 to April 2024. Non-singleton pregnancies were excluded. Women were divided into those reviewed prior to 10 weeks’ gestation (early-DM) and those who were first reviewed after 10 weeks’ gestation (late-DM).

Results

There were 242 cases of women with pre-gestational diabetes and singleton pregnancies who attended the Diabetes Service over this period, of which 33.9% (n=82) were reviewed by the diabetes team prior to ten weeks’ gestation. Majority of cases had Type 2 diabetes (n = 188, 77.7%). The early-DM group were younger (31.5±4.8 vs 33.5±5.1 years, p=0.003), had lower body mass index (29.0 vs 31.5kg/m2, p=0.008), were more likely to have Type 1 diabetes (36.9% vs 15.7%, p=0.005), and also had greater usage of insulin pumps (11.5% vs 1.5%, p=0.005) compared to the late-DM group. There were no differences in parity, first HbA1c during pregnancy, and incidence of pre-existing hypertension between the two groups. Of the 242 pregnancies, 233 (96.3%) progressed to delivery of a live neonate. Women in the early-DM group were significantly less likely to develop pre-eclampsia (OR 0.457, p=0.048), and their infants were less likely to sustain birth trauma (OR 0.140, p=0.029). However, foetal demise in-utero was more commonly observed in the early-DM group (OR 17.2, p<0.001). It was noted that six out of the eight foetal deaths in this group occurred prior to end of first trimester. Of the live births, there was no significant difference in the incidence of neonatal intensive care admission, hypoglycaemia, jaundice, congenital abnormalities, macrosomia, or pre-maturity between the two groups.

Conclusions

Early antenatal referral may lead to reduction in the incidence of pre-eclampsia as well as birth trauma during delivery in women with pre-gestational diabetes, but there was no difference in other pregnancy outcomes. We believe pre-pregnancy planning together is important, and together with early antenatal management of these women may further improve pregnancy outcomes.