Ten Years of Optimizing Outcomes for Women With Type 1 and Type 2 Diabetes in Pregnancy—The Atlantic DIP Experience

Lisa A Owens, Aoife M Egan, Louise Carmody, Fidelma Dunne

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 we now share outcomes over our first decade in caring for pregnant women with diabetes. The objective was to assess improvements in clinical outcomes after introduction of interventions. We retrospectively examined 445 pregnancies in women with Type 1 and Type 2 diabetes and compared them over two time points, 2005-2009,2010-2014. Interventions introduced over that time include; provision of combined antenatal/diabetes clinics, pre-pregnancy care, electronic data management, local clinical care guidelines, professional and patient education materials, an app and website. Pregnancy outcomes Results: The introduction of the Atlantic DIP program has been associated with a reduction in adverse neonatal outcomes. There has been a reduction in congenital malformations (5% to 1.8%,p=0.04), stillbirths (2.3 v 0.4%,P=0.09), despite an upward trend in maternal age (mean age 31.7 v 33), obesity (29% v 43% BMI>30kg/m(2)) and excessive gestational weight gain (24% v 38%,p=0.002). These improvements in outcomes occur alongside an increase in attendance at pre-pregnancy care (23% to 49%,p<0.001), use of folic acid (45 v 71%,p<0.001) and sustained improvement in glycemic control. Changing the process of clinical care delivery and utilizing evidence-based interventions in a pragmatic clinical setting improves pregnancy outcomes for women with pre-gestational diabetes. We now need to target optimization of maternal body mass index prior to pregnancy and put a greater focus on gestational weight gain through education and monitoring.