dc.contributor.author | Owens, Lisa A. | |
dc.contributor.author | Egan, Aoife M. | |
dc.contributor.author | Carmody, Louise | |
dc.contributor.author | Dunne, Fidelma | |
dc.date.accessioned | 2018-09-20T16:20:55Z | |
dc.date.available | 2018-09-20T16:20:55Z | |
dc.date.issued | 2016-04-01 | |
dc.identifier.citation | Owens, Lisa A. Egan, Aoife M.; Carmody, Louise; Dunne, Fidelma (2016). Ten years of optimizing outcomes for women with type 1 and type 2 diabetes in pregnancy—the atlantic dip experience. The Journal of Clinical Endocrinology & Metabolism 101 (4), 1598-1605 | |
dc.identifier.issn | 0021-972X,1945-7197 | |
dc.identifier.uri | http://hdl.handle.net/10379/13380 | |
dc.description.abstract | Context: Pregnancy for women with type 1 or type 2 diabetes is a time of increased risk for both mother and baby. The Atlantic Diabetes in Pregnancy program provides coordinated, evidence-based care for women with diabetes in Ireland. Founded in 2005, the program now shares outcomes over its first decade in caring for pregnant women with diabetes.
Objective: The objective was to assess improvements in clinical outcomes after the introduction of interventions.
Design, Setting, Participants: We retrospectively examined 445 pregnancies in women with type 1 and type 2 diabetes and compared them over two timepoints, 2005-2009 and 2010-2014.
Interventions: Interventions introduced over that time include: provision of combined antenatal/diabetes clinics, prepregnancy care, electronic data management, local clinical care guidelines, professional and patient education materials, an app, and a web site.
Main Outcomes: Pregnancy outcomes were measured.
Results: The introduction of the Atlantic Diabetes in Pregnancy program has been associated with a reduction in adverse neonatal outcomes. There has been a reduction in congenital malformations (5 to 1.8%; P = .04), stillbirths (2.3 vs 0.4%; P = .09), despite an upward trend in maternal age (mean age, 31.7 vs 33 years), obesity (29 vs 43%; body mass index >30 kg/m(2)), and excessive gestational weight gain (24 vs 38%; P = .002). These improvements in outcomes occur alongside an increase in attendance at prepregnancy care (23 to 49%; P = .001), use of folic acid (45 vs 71%; P = .001), and sustained improvement in glycemic control.
Conclusions: Changing the process of clinical care delivery and utilizing evidence-based interventions in a pragmatic clinical setting improves pregnancy outcomes for women with pregestational diabetes. We now need to target optimization of maternal body mass index before pregnancy and put a greater focus on gestational weight gain through education and monitoring. | |
dc.publisher | The Endocrine Society | |
dc.relation.ispartof | The Journal of Clinical Endocrinology & Metabolism | |
dc.rights | Attribution-NonCommercial-NoDerivs 3.0 Ireland | |
dc.rights.uri | https://creativecommons.org/licenses/by-nc-nd/3.0/ie/ | |
dc.subject | gestational weight-gain | |
dc.subject | congenital-malformations | |
dc.subject | prepregnancy care | |
dc.subject | preconception care | |
dc.subject | cesarean-section | |
dc.subject | fetal outcomes | |
dc.subject | risk | |
dc.subject | insulin | |
dc.subject | metformin | |
dc.subject | metaanalysis | |
dc.title | Ten years of optimizing outcomes for women with type 1 and type 2 diabetes in pregnancy—the atlantic dip experience | |
dc.type | Article | |
dc.identifier.doi | 10.1210/jc.2015-3817 | |
dc.local.publishedsource | https://academic.oup.com/jcem/article-pdf/101/4/1598/10429311/jcem1598.pdf | |
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