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Abstract
BackgroundPre-gestational diabetes mellitus is associated with increased risk for maternal and fetal adverse outcomes. This systematic review was carried out to evaluate the effectiveness and safety of pre-pregnancy care in improving the rate of congenital malformations and perinatal mortality for women with pre-gestational diabetes mellitus.MethodsWe searched the following databases, MEDLINE, EMBASE, WEB OF SCIENCE, Cochrane Library, including the CENTRAL register of controlled trials and CINHAL up to December 2011, without language restriction, for any pre-pregnancy care aiming at health promotion, glycemic control and screening and treatment of diabetes complications in women with type I or type II diabetes mellitus. Study design were trials (randomized and non-randomized), cohort and case–control studies.ResultsOf the 2452 title scanned 54 full papers were retrieved of those 21 studies were included in this review. Twelve cohort studies at low and medium risk of bias, with 3088 women, were included in the meta-analysis. Meta-analysis suggested that pre-pregnancy care is effective in reducing congenital malformation, Risk Ratio (RR) 0.25 (95% CI 0.16-0.37), number needed to treat (NNT) 19 (95% CI 14–24), and perinatal mortality RR 0.34 (95% CI 0.15-0.75), NNT = 46 (95% CI 28–115). Pre-pregnancy care lowers glycosylated hemoglobin A1c (HbA1c) in the first trimester of pregnancy by an average of 1.92% (95% CI −2.05 to −1.79). However women who received pre-pregnancy care were at increased risk of hypoglycemia during the first trimester of pregnancy RR 1.51 (95% CI 1.15-1.99).ConclusionPre-pregnancy care for women with pre-gestational type 1 or type 2 diabetes mellitus is effective in improving rates of congenital malformations, perinatal mortality and in reducing maternal HbA1C in the first trimester of pregnancy. Pre-pregnancy care might cause maternal hypoglycemia in the first trimester of pregnancy.
Highlights
Pre-gestational diabetes mellitus is associated with increased risk for maternal and fetal adverse outcomes
A total of 25 reports of 21 studies were included in this review [7,8,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33]. (Three articles described the same cohort study with two interim [15,16] and one final report [17], one study reported the outcomes for the same cohort in two articles [7,27] and two articles report the outcomes of one cohort with one interim [29] and one final report [26])
All studies did not address the effect of the presence of confounding factors on the outcomes except for three reports which used regression analysis to evaluate the effectiveness of the pre-pregnancy care (PPC) [7,8,27]
Summary
Pre-gestational diabetes mellitus is associated with increased risk for maternal and fetal adverse outcomes. This systematic review was carried out to evaluate the effectiveness and safety of pre-pregnancy care in improving the rate of congenital malformations and perinatal mortality for women with pre-gestational diabetes mellitus. Glycemic control is one of the most important aspects of pre-pregnancy care (PPC) [6]; other aspects of care such as folic acid supplementation, smoking cessation, screening and treatment of diabetes complications and discontinuing teratogenic medications, are as important for improving maternal and fetal outcomes and might be effective in reducing the rate of CM to the background level [7,8,9]. The aim of this systematic review is to assess the effectiveness and safety of PPC in improving the CM and perinatal mortality for women with type 1 or type 2 PGDM
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