Pregnancy of women with type 1 diabetes mellitus - the effect of preconception care on perinatal results. Ten years of experience.

Abstract

Despite the ever-improving medical care, pregnancies of women with type 1diabetes mellitus (T1DM) are at increased risk of complications for both mother and child. Optimal compensation of diabetes before and during pregnancy is an essential protective factor reducing the risk of congenital malformations, pregnancy loss, and other complications. The pregnancy of women with T1DM should be planned, ideally at atime of optimal diabetes compensation. Target glycated hemoglobin (HbA1c) values until the range of 42-48mmol/mol should be achieved at least three months before pregnancy. Our work aimed to evaluate the perinatal results of pregnancies in women with T1DM and the eff ect of preconception counseling and adequate T1DM compensation before pregnancy on perinatal outcomes. Retrospective analysis of pregnancy and perinatal outcomes of women with T1DM were followed up at the Department of Gynecology and Obstetrics, General University Hospital in Prague and First Faculty of Medicine, Charles University between 2008to 2018. Atotal of 221women with T1DM were included in the analysis. Adequate (HbA1c48mmol/mol at least 3 months before conception) and inadequate diabetes compensation at the beginning of the pregnancy had 59(26.7%) and 162(72.3%) women, respectively. Pregnancies of women with adequate diabetes compensation were more often planned (55.9 vs. 24.7%; P95th percentile; 22.0 vs. 35.8%; P=0.027). The pregnancy of women with T1DM is burdened by anumber of perinatal and neonatal complications. In the study group, most women with T1DM became pregnant unintentionally at atime of inadequate diabetes compensation. Women who achieved adequate diabetes compensation before pregnancy had alower incidence of perinatal complications. Therefore, it is advised that women with T1DM should plan their pregnancy, attend preconception and antenatal care, and give birth in perinatal centers, which provide coordinated care from diabetologists, gynecologists, obstetricians, and neonatologists.