A Prepregnancy Care Program for Women With Diabetes: Effective and Cost Saving.

Aoife M Egan, Andriy Danyliv, Louise Carmody, Breda Kirwan, Fidelma P Dunne

Only a minority of women with diabetes attend prepregnancy care and the economic effects of providing the service are unclear. To design, put into practice and evaluate a regional prepregnancy care program for women with type 1 and 2 diabetes. A prospective cohort and cost-analysis study. Antenatal centres along the Irish Atlantic Seaboard. Four hundred and fourteen women with type 1 or 2 diabetes. A newly developed prepregnancy care program. The program was assessed for its effect on the risk of adverse pregnancy outcomes. The difference between program delivery cost and the excess cost of treating adverse outcomes in non-attendees was evaluated. In total, 149 (36%) attended- this increased from 19% to 50% after increased recruitment measures in 2010. Attendees were more likely to take preconception folic acid (97.3 vs 57.7%, p<0.001) and less likely to smoke (8.7 vs 16.6%, p=0.03) or take potentially teratogenic medications at conception (0.7 vs 6.0, p=0.008). Attendees had lower HbA1c levels throughout pregnancy (first trimester HbA1c: 6.8 vs 7.7%, p<0.001, third trimester HbA1c: 6.1 vs 6.5%, p=0.001) and their offspring had lower rates of serious adverse outcome (2.4 vs 10.5%, p=0.007). The adjusted difference in complication costs between those who received prepregnancy care versus usual antenatal care only is €2,578.00. The average cost of prepregnancy care delivery is €449.00 per pregnancy. This regional prepregnancy care program is clinically effective. The cost of program delivery is less than the excess cost of managing adverse pregnancy outcomes.