200-LB: Pregestational Diabetes and Pregnancy Outcomes

Abstract

Pre-gestational diabetes, type 1 diabetes (T1DM) and type 2 diabetes (T2DM) are associated with adverse outcomes: miscarriage, stillbirth, macrosomia and increased rates of emergency cesarean sections (EMCS). We reviewed 175 women with pre-gestational diabetes who attended the National Maternity Hospital in Dublin, Ireland between 2015 to 2017. Fifty women (28.6%) had T2DM and 125 women (71.4%) had T1DM. The mean age for T1DM group was (34 ± 4.7years) and T2DM (35.5 ± 3.8 years). Most of our patients were of European descent (85%) others were mostly of Asian and North African origin (15%). Mean duration of diabetes was 5.4 years in T2DM and 15.7 years in T1DM. Structured pre-pregnancy planning attended by 38.3% of our patients. Pre-pregnancy folic acid was used by 45.7% of patients for at least one month prior to booking. Forty women (29%) of T1DM were on Continuous Subcutaneous Insulin Infusion (CSII). Patients with T2DM were treated with Metformin (20%) only, Metformin and multiple dose insulin (MDI) injection combined (44%), MDI (28%) and diet control alone (2%). Mean BMI for T2DM was 32.6 ± 8.1 kg/m2 at booking and for T1DM 26.2 ± 4.5 kg/m2. Diabetic Retinopathy was more frequent in T1DM. The HBA1C in CSII group was 53.5 mmol/mol in the first trimester and improved to 42.9 mmol/mol in the third. T1DM group on MDI had HBA1C of 56.9 mmo/mol at booking and 44.7 mmol/mol in the third trimester. The mean HBA1C in T2DM at booking was 44.5 mmol/mol and 37.5 mmol/mol in the third trimester. Cesarean section (CS) was common in T1DM 48% with mostly EMCS 32%. In T2DM rate of CS was 38%. The most neonatal ICU (NICU) admission was due to hypoglycemia; in the T1DM group was 16.5% and 10% in T2DM group. Total neonatal birth weights above 4.0 Kg in our cohort was 21.7%. Our cohort with pre-gestational diabetes were overweight, older with long standing diabetes. Initial inadequate diabetes control in T1DM was better in patients with CSII with a significant improvement during pregnancy in all patients. With appropriate multidisciplinary treatment we minimized adverse outcomes. Disclosure D.S.A. Ali: None. M. Hatunic: None.