Pregnancy outcome in women with pregestational diabetes mellitus at a district general hospital in Australia

Abstract

AbstractThe global incidence of pregestational diabetes mellitus (PGDM) is on the increase. Pregnancy outcome in these women is much worse compared to those without diabetes, from higher rates of miscarriage, congenital malformations and perinatal mortality. This small audit is a retrospective case note analysis of women with PGDM birthing over 12 months at a health facility in Australia serving a high‐risk and migrant multicultural population.The local prevalence of PGDM was high (0.63%). A large number (56.5%) of the 23 women whose case notes were analysed were older (>30 years) and, of these, 77% were non‐Caucasians. Six women were pregnant for the first time. Many (69%) were on preconception folate supplementation. Data on satisfactory pre‐pregnancy glycaemic control (HbA1c > 6.1% [43mmol/mol]) were found in two women and, though HbA1c was >7.1% (54mmol/mol)‐ in some, HbA1c readings in all three trimesters were not identified for each woman. Nine women used metformin and insulin was prescribed in the vast majority (82.6%). Overall, vaginal birth rate was 43% which was even higher (58.8%) among those who attempted vaginal birth, seemingly higher than national figures. Mean gestation at delivery was 37 weeks with four macrosomic (>4.5kg) babies. There was one stillbirth and the neonatal morbidities were in keeping with average. Breastfeeding rates were compatible with the baby‐friendly status of the hospital.Following this audit, the provision of antenatal care for this high‐risk pregnancy group has been changed in order to improve the quality of care. This is due for re‐audit in due course. Copyright © 2012 John Wiley & Sons.