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Fidelma Dunne - One of the best experts on this subject based on the ideXlab platform.
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1429 p a review of Prepregnancy Care and pregnancy outcomes in pregestational diabetes are prior improvements in pregnancy preparation and outcomes maintained for women with pregestational diabetes
Diabetes, 2019Co-Authors: Christine Newman, Aoife M. Egan, Louise Carmody, Lisa A. Owens, Fidelma DunneAbstract:Women with pre-existing diabetes (T1DM/T2DM) face increased risk in pregnancy. Optimising glycaemic control, folic acid use and smoking cessation are all advised to improve outcomes. Maintaining these goals can be difficult. We retrospectively analysed data from sites across our Atlantic DIP network from 2015-17 and compared outcomes to data 2010-14 to see if prior improvements were maintained. Data was collected on pre-pregnancy Care (PPC), glycaemic targets and neonatal outcomes. In total 98 women attended; 76 (78%)/22 (22%) with T1DM and T2DM respectively. Booking maternal BMI reduced but a fall in PPC attendance lead to lower folic acid use, greater teratogenic medication use and static smoking rates. Trimester 1 HbA1C was suboptimal in T1DM but patients subsequently reached target. HbA1C improved throughout pregnancy for T2DM and was at target (Table 1). Between the two time periods outcomes were unchanged for miscarriage, shoulder dystocia, NICU admission, macrosomia, LGA, SGA and birth weight. We recorded no stillbirths or congenital malformations. Improvements occurred in prematurity ( It is reassuring to record maintenance/improvement in neonatal outcomes but ongoing education on the importance of PPC and novel ways to reach patients are required. Disclosure C. Newman: Speaker9s Bureau; Self; Sanofi. L. Carmody: None. A.M. Egan: None. L.A. Owens: None. F. Dunne: None.
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1429-P: A Review of Prepregnancy Care and Pregnancy Outcomes in Pregestational Diabetes—Are Prior Improvements in Pregnancy Preparation and Outcomes Maintained for Women with Pregestational Diabetes?
Diabetes, 2019Co-Authors: Christine Newman, Aoife M. Egan, Louise Carmody, Lisa A. Owens, Fidelma DunneAbstract:Women with pre-existing diabetes (T1DM/T2DM) face increased risk in pregnancy. Optimising glycaemic control, folic acid use and smoking cessation are all advised to improve outcomes. Maintaining these goals can be difficult. We retrospectively analysed data from sites across our Atlantic DIP network from 2015-17 and compared outcomes to data 2010-14 to see if prior improvements were maintained. Data was collected on pre-pregnancy Care (PPC), glycaemic targets and neonatal outcomes. In total 98 women attended; 76 (78%)/22 (22%) with T1DM and T2DM respectively. Booking maternal BMI reduced but a fall in PPC attendance lead to lower folic acid use, greater teratogenic medication use and static smoking rates. Trimester 1 HbA1C was suboptimal in T1DM but patients subsequently reached target. HbA1C improved throughout pregnancy for T2DM and was at target (Table 1). Between the two time periods outcomes were unchanged for miscarriage, shoulder dystocia, NICU admission, macrosomia, LGA, SGA and birth weight. We recorded no stillbirths or congenital malformations. Improvements occurred in prematurity ( It is reassuring to record maintenance/improvement in neonatal outcomes but ongoing education on the importance of PPC and novel ways to reach patients are required. Disclosure C. Newman: Speaker9s Bureau; Self; Sanofi. L. Carmody: None. A.M. Egan: None. L.A. Owens: None. F. Dunne: None.
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A Prepregnancy Care Program for Women With Diabetes: Effective and Cost Saving.
The Journal of clinical endocrinology and metabolism, 2016Co-Authors: Aoife M. Egan, Andriy Danyliv, Louise Carmody, Breda Kirwan, Fidelma DunneAbstract:Context: Only a minority of women with diabetes attend Prepregnancy Care service and the economic effects of providing this service are unclear. Objective: The objective of the study was to design, put into practice, and evaluate a regional Prepregnancy Care program for women with types 1 and 2 diabetes. Design: This was a prospective cohort and cost-analysis study. Setting: The study was conducted at antenatal centers along the Irish Atlantic Seaboard. Participants: Four hundred fourteen women with type 1 or 2 diabetes participated in the study. Intervention: The intervention for the study was a newly developed Prepregnancy Care program. Main Outcome Measures: 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 nonattendees was evaluated. Results: In total, 149 (36%) attended: this increased from 19% to 50% after increased recruitment measures in 2010. Attendees were more likely...
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Ten years of optimizing outcomes for women with type 1 and type 2 diabetes in pregnancy—the atlantic dip experience
The Journal of clinical endocrinology and metabolism, 2016Co-Authors: L Owens, Aoife M. Egan, Louise Carmody, Fidelma DunneAbstract:Context 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, the program now shares outcomes over its first decade in caring for pregnant women with diabetes. Objective The objective was to assess improvements in clinical outcomes after the introduction of interventions. Design, setting, participants We retrospectively examined 445 pregnancies in women with type 1 and type 2 diabetes and compared them over two timepoints, 2005–2009 and 2010–2014. Inteventions Interventions introduced over that time include: provision of combined antenatal/diabetes clinics, Prepregnancy Care, electronic data management, local clinical Care guidelines, professional and patient education materials, an app, and a web site. Main outcomes Pregnancy outcomes were measured. Results The introduction of the Atlantic Diabetes in Pregnancy program has been associated with a reduction in adverse neonatal outcomes. There has been a reduction in congenital malformations (5 to 1.8%; P = .04), stillbirths (2.3 vs 0.4%; P = .09), despite an upward trend in maternal age (mean age, 31.7 vs 33 years), obesity (29 vs 43%; body mass index >30 kg/m2), and excessive gestational weight gain (24 vs 38%; P = .002). These improvements in outcomes occur alongside an increase in attendance at Prepregnancy Care (23 to 49%; P Conclusions Changing the process of clinical Care delivery and utilizing evidence-based interventions in a pragmatic clinical setting improves pregnancy outcomes for women with pregestational diabetes. We now need to target optimization of maternal body mass index before pregnancy and put a greater focus on gestational weight gain through education and monitoring.
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Effectiveness of Prepregnancy Care for women with pregestational diabetes mellitus: protocol for a systematic review of the literature and identification of a core outcomes set using a Delphi survey
Trials, 2015Co-Authors: Aoife M. Egan, Valerie Smith, Declan Devane, Fidelma DunneAbstract:Women with pregnancy complicated by pregestational diabetes experience increased rates of adverse pregnancy outcomes. Prepregnancy Care is the targeted support and additional Care offered to those women who are planning pregnancy and is associated with improved outcomes. However, there is significant heterogeneity in the outcomes measured and reported in studies evaluating the effects of Prepregnancy Care, which makes meaningful comparison difficult. The aim of this article is to present a protocol for a study to develop a Core Outcome Set (COS) for trials and other studies evaluating the effectiveness of Prepregnancy Care for women with pregestational diabetes mellitus. This study will include a systematic review of the literature to identify outcomes that have previously been reported in studies evaluating Prepregnancy Care for women with pregestational diabetes. We will then prioritise these outcomes from the perspective of key stakeholders, including women with pregestational diabetes as well as clinicians, using a Delphi survey. A final consensus meeting will be held with stakeholders to review and finalise the outcomes. The expectation is that the COS will always be collected and reported in all clinical trials, audits of practice and other forms of research that involve Prepregnancy Care programs for women with pregestational diabetes. This will facilitate comparing and contrasting of studies and allow for combining of appropriate studies with the ultimate goal of improved patient Care.
Aoife M. Egan - One of the best experts on this subject based on the ideXlab platform.
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1429 p a review of Prepregnancy Care and pregnancy outcomes in pregestational diabetes are prior improvements in pregnancy preparation and outcomes maintained for women with pregestational diabetes
Diabetes, 2019Co-Authors: Christine Newman, Aoife M. Egan, Louise Carmody, Lisa A. Owens, Fidelma DunneAbstract:Women with pre-existing diabetes (T1DM/T2DM) face increased risk in pregnancy. Optimising glycaemic control, folic acid use and smoking cessation are all advised to improve outcomes. Maintaining these goals can be difficult. We retrospectively analysed data from sites across our Atlantic DIP network from 2015-17 and compared outcomes to data 2010-14 to see if prior improvements were maintained. Data was collected on pre-pregnancy Care (PPC), glycaemic targets and neonatal outcomes. In total 98 women attended; 76 (78%)/22 (22%) with T1DM and T2DM respectively. Booking maternal BMI reduced but a fall in PPC attendance lead to lower folic acid use, greater teratogenic medication use and static smoking rates. Trimester 1 HbA1C was suboptimal in T1DM but patients subsequently reached target. HbA1C improved throughout pregnancy for T2DM and was at target (Table 1). Between the two time periods outcomes were unchanged for miscarriage, shoulder dystocia, NICU admission, macrosomia, LGA, SGA and birth weight. We recorded no stillbirths or congenital malformations. Improvements occurred in prematurity ( It is reassuring to record maintenance/improvement in neonatal outcomes but ongoing education on the importance of PPC and novel ways to reach patients are required. Disclosure C. Newman: Speaker9s Bureau; Self; Sanofi. L. Carmody: None. A.M. Egan: None. L.A. Owens: None. F. Dunne: None.
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1429-P: A Review of Prepregnancy Care and Pregnancy Outcomes in Pregestational Diabetes—Are Prior Improvements in Pregnancy Preparation and Outcomes Maintained for Women with Pregestational Diabetes?
Diabetes, 2019Co-Authors: Christine Newman, Aoife M. Egan, Louise Carmody, Lisa A. Owens, Fidelma DunneAbstract:Women with pre-existing diabetes (T1DM/T2DM) face increased risk in pregnancy. Optimising glycaemic control, folic acid use and smoking cessation are all advised to improve outcomes. Maintaining these goals can be difficult. We retrospectively analysed data from sites across our Atlantic DIP network from 2015-17 and compared outcomes to data 2010-14 to see if prior improvements were maintained. Data was collected on pre-pregnancy Care (PPC), glycaemic targets and neonatal outcomes. In total 98 women attended; 76 (78%)/22 (22%) with T1DM and T2DM respectively. Booking maternal BMI reduced but a fall in PPC attendance lead to lower folic acid use, greater teratogenic medication use and static smoking rates. Trimester 1 HbA1C was suboptimal in T1DM but patients subsequently reached target. HbA1C improved throughout pregnancy for T2DM and was at target (Table 1). Between the two time periods outcomes were unchanged for miscarriage, shoulder dystocia, NICU admission, macrosomia, LGA, SGA and birth weight. We recorded no stillbirths or congenital malformations. Improvements occurred in prematurity ( It is reassuring to record maintenance/improvement in neonatal outcomes but ongoing education on the importance of PPC and novel ways to reach patients are required. Disclosure C. Newman: Speaker9s Bureau; Self; Sanofi. L. Carmody: None. A.M. Egan: None. L.A. Owens: None. F. Dunne: None.
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A core outcome set for studies evaluating the effectiveness of Prepregnancy Care for women with pregestational diabetes
Diabetologia, 2017Co-Authors: Aoife M. Egan, Sander Galjaard, Michael Maresh, Mary R. Loeken, Angela Napoli, Eleni Anastasiou, Eoin Noctor, Harold W. De Valk, Mireille Poppel, Marie ToddAbstract:Aims/hypothesis The aim of this study was to develop a core outcome set (COS) for trials and other studies evaluating the effectiveness of Prepregnancy Care for women with pregestational (pre-existing) diabetes mellitus. Methods A systematic literature review was completed to identify all outcomes reported in prior studies in this area. Key stakeholders then prioritised these outcomes using a Delphi study. The list of outcomes included in the final COS were finalised at a face-to-face consensus meeting. Results In total, 17 outcomes were selected and agreed on for inclusion in the final COS. These outcomes were grouped under three domains: measures of pregnancy preparation ( n = 9), neonatal outcomes ( n = 6) and maternal outcomes ( n = 2). Conclusions/interpretation This study identified a COS essential for studies evaluating Prepregnancy Care for women with pregestational diabetes. It is advocated that all trials and other non-randomised studies and audits in this area use this COS with the aim of improving transparency and the ability to compare and combine future studies with greater ease.
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A core outcome set for studies evaluating the effectiveness of Prepregnancy Care for women with pregestational diabetes.
Diabetologia, 2017Co-Authors: Aoife M. Egan, Sander Galjaard, Michael Maresh, Mary R. Loeken, Angela Napoli, Eleni Anastasiou, Eoin Noctor, Harold W. De Valk, Mireille N M Van Poppel, Marie ToddAbstract:Aims/hypothesis The aim of this study was to develop a core outcome set (COS) for trials and other studies evaluating the effectiveness of Prepregnancy Care for women with pregestational (pre-existing) diabetes mellitus.
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A Prepregnancy Care Program for Women With Diabetes: Effective and Cost Saving.
The Journal of clinical endocrinology and metabolism, 2016Co-Authors: Aoife M. Egan, Andriy Danyliv, Louise Carmody, Breda Kirwan, Fidelma DunneAbstract:Context: Only a minority of women with diabetes attend Prepregnancy Care service and the economic effects of providing this service are unclear. Objective: The objective of the study was to design, put into practice, and evaluate a regional Prepregnancy Care program for women with types 1 and 2 diabetes. Design: This was a prospective cohort and cost-analysis study. Setting: The study was conducted at antenatal centers along the Irish Atlantic Seaboard. Participants: Four hundred fourteen women with type 1 or 2 diabetes participated in the study. Intervention: The intervention for the study was a newly developed Prepregnancy Care program. Main Outcome Measures: 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 nonattendees was evaluated. Results: In total, 149 (36%) attended: this increased from 19% to 50% after increased recruitment measures in 2010. Attendees were more likely...
Mary R. Loeken - One of the best experts on this subject based on the ideXlab platform.
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A core outcome set for studies evaluating the effectiveness of Prepregnancy Care for women with pregestational diabetes
Diabetologia, 2017Co-Authors: Aoife M. Egan, Sander Galjaard, Michael Maresh, Mary R. Loeken, Angela Napoli, Eleni Anastasiou, Eoin Noctor, Harold W. De Valk, Mireille Poppel, Marie ToddAbstract:Aims/hypothesis The aim of this study was to develop a core outcome set (COS) for trials and other studies evaluating the effectiveness of Prepregnancy Care for women with pregestational (pre-existing) diabetes mellitus. Methods A systematic literature review was completed to identify all outcomes reported in prior studies in this area. Key stakeholders then prioritised these outcomes using a Delphi study. The list of outcomes included in the final COS were finalised at a face-to-face consensus meeting. Results In total, 17 outcomes were selected and agreed on for inclusion in the final COS. These outcomes were grouped under three domains: measures of pregnancy preparation ( n = 9), neonatal outcomes ( n = 6) and maternal outcomes ( n = 2). Conclusions/interpretation This study identified a COS essential for studies evaluating Prepregnancy Care for women with pregestational diabetes. It is advocated that all trials and other non-randomised studies and audits in this area use this COS with the aim of improving transparency and the ability to compare and combine future studies with greater ease.
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A core outcome set for studies evaluating the effectiveness of Prepregnancy Care for women with pregestational diabetes.
Diabetologia, 2017Co-Authors: Aoife M. Egan, Sander Galjaard, Michael Maresh, Mary R. Loeken, Angela Napoli, Eleni Anastasiou, Eoin Noctor, Harold W. De Valk, Mireille N M Van Poppel, Marie ToddAbstract:Aims/hypothesis The aim of this study was to develop a core outcome set (COS) for trials and other studies evaluating the effectiveness of Prepregnancy Care for women with pregestational (pre-existing) diabetes mellitus.
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Challenges in Understanding Diabetic Embryopathy
2016Co-Authors: Mary R. LoekenAbstract:Perhaps one of the most devastating diabetescomplications is diabetic embryopathy, in whichthe offspring of a mother with diabetes predatingpregnancy develops congenital malformations. These malformations can affect multiple organ systems, including the brain and spinal cord, the heart and major vessel, the kidneys, the gut, and skeletal structures (1,2) and result in pre- or postnatal mortality or disability. As malformations are induced during the earliest stages of organogenesis, coinciding with the first recognition of pregnancy (3), it is important to institute rigorous glyce-mic control before the onset of pregnancy. Nevertheless, recent studies (4,5) have shown that even in planned pregnancies with optimal Prepregnancy Care, the inci-dence of malformations in diabetic pregnancies is still at least twice that in nondiabetic pregnancies. As malforma-tions occur in the offspring of women with either type 1 or type 2 diabetes (or offspring of women who are obes
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Challenges in Understanding Diabetic Embryopathy
Diabetes, 2008Co-Authors: Mary R. LoekenAbstract:Perhaps one of the most devastating diabetes complications is diabetic embryopathy, in which the offspring of a mother with diabetes predating pregnancy develops congenital malformations. These malformations can affect multiple organ systems, including the brain and spinal cord, the heart and major vessel, the kidneys, the gut, and skeletal structures (1,2) and result in pre- or postnatal mortality or disability. As malformations are induced during the earliest stages of organogenesis, coinciding with the first recognition of pregnancy (3), it is important to institute rigorous glycemic control before the onset of pregnancy. Nevertheless, recent studies (4,5) have shown that even in planned pregnancies with optimal Prepregnancy Care, the incidence of malformations in diabetic pregnancies is still at least twice that in nondiabetic pregnancies. As malformations occur in the offspring of women with either type 1 or type 2 diabetes (or offspring of women who are obese at the beginning of pregnancy and may have undiagnosed type 2 diabetes) (2,6–8), and recent evidence indicates that the incidence of diabetes, particularly type 2 diabetes, predating pregnancy is rapidly increasing (9), the burden of this diabetes complication is likely to increase in coming years unless efforts to prevent diabetic embryopathy are improved. However, unlike other diabetes complications, in which the development of pharmacologic interventions offer the hope of treatment or prevention, prevention of …
Juno Obedin-maliver - One of the best experts on this subject based on the ideXlab platform.
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Prepregnancy Counseling for People of All Genders: Enhancing Safe and Accessible Family Building for Transgender, Gender Diverse, and Non-binary Individuals
Current Obstetrics and Gynecology Reports, 2020Co-Authors: Erica Martinez, Augustus Klein, Juno Obedin-maliverAbstract:Purpose of Review The purpose of this narrative review is to expand routine Prepregnancy counseling and anticipatory guidance to include people of all genders. Recent Findings Transgender, gender diverse, and non-binary (TGNB) individuals who were assigned female at birth may wish to parent, conceive, and carry a pregnancy, but are not included in guidelines for routine Prepregnancy counseling. In addition to the topics covered in routine Prepregnancy counseling, there are several unique considerations for Prepregnancy Care for TGNB individuals including perinatal testosterone use, gender dysphoria and distress, chest/breastfeeding, and navigation of clinical environments. Summary Research in the area of TGNB medical Care continues to grow as the visibility of these communities increases. However, data are limited surrounding pregnancy and Prepregnancy-related Care. Therefore, we present Prepregnancy medical, surgical, social, and practice of Care considerations for TGNB populations in light of other known health and healthCare experiences of TGNB patients. We outline several clinical recommendations to support clinicians in providing inclusive Prepregnancy Care. These recommendations aim to highlight the unique needs of TGNB individuals while recognizing that each patient’s experience and goals must be individualized to them.
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Prepregnancy Counseling for People of All Genders: Enhancing Safe and Accessible Family Building for Transgender, Gender Diverse, and Non-binary Individuals
Current Obstetrics and Gynecology Reports, 2020Co-Authors: Erica I. Martinez, Augustus Klein, Juno Obedin-maliverAbstract:The purpose of this narrative review is to expand routine Prepregnancy counseling and anticipatory guidance to include people of all genders. Transgender, gender diverse, and non-binary (TGNB) individuals who were assigned female at birth may wish to parent, conceive, and carry a pregnancy, but are not included in guidelines for routine Prepregnancy counseling. In addition to the topics covered in routine Prepregnancy counseling, there are several unique considerations for Prepregnancy Care for TGNB individuals including perinatal testosterone use, gender dysphoria and distress, chest/breastfeeding, and navigation of clinical environments. Research in the area of TGNB medical Care continues to grow as the visibility of these communities increases. However, data are limited surrounding pregnancy and Prepregnancy-related Care. Therefore, we present Prepregnancy medical, surgical, social, and practice of Care considerations for TGNB populations in light of other known health and healthCare experiences of TGNB patients. We outline several clinical recommendations to support clinicians in providing inclusive Prepregnancy Care. These recommendations aim to highlight the unique needs of TGNB individuals while recognizing that each patient’s experience and goals must be individualized to them.
Louise Carmody - One of the best experts on this subject based on the ideXlab platform.
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1429 p a review of Prepregnancy Care and pregnancy outcomes in pregestational diabetes are prior improvements in pregnancy preparation and outcomes maintained for women with pregestational diabetes
Diabetes, 2019Co-Authors: Christine Newman, Aoife M. Egan, Louise Carmody, Lisa A. Owens, Fidelma DunneAbstract:Women with pre-existing diabetes (T1DM/T2DM) face increased risk in pregnancy. Optimising glycaemic control, folic acid use and smoking cessation are all advised to improve outcomes. Maintaining these goals can be difficult. We retrospectively analysed data from sites across our Atlantic DIP network from 2015-17 and compared outcomes to data 2010-14 to see if prior improvements were maintained. Data was collected on pre-pregnancy Care (PPC), glycaemic targets and neonatal outcomes. In total 98 women attended; 76 (78%)/22 (22%) with T1DM and T2DM respectively. Booking maternal BMI reduced but a fall in PPC attendance lead to lower folic acid use, greater teratogenic medication use and static smoking rates. Trimester 1 HbA1C was suboptimal in T1DM but patients subsequently reached target. HbA1C improved throughout pregnancy for T2DM and was at target (Table 1). Between the two time periods outcomes were unchanged for miscarriage, shoulder dystocia, NICU admission, macrosomia, LGA, SGA and birth weight. We recorded no stillbirths or congenital malformations. Improvements occurred in prematurity ( It is reassuring to record maintenance/improvement in neonatal outcomes but ongoing education on the importance of PPC and novel ways to reach patients are required. Disclosure C. Newman: Speaker9s Bureau; Self; Sanofi. L. Carmody: None. A.M. Egan: None. L.A. Owens: None. F. Dunne: None.
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1429-P: A Review of Prepregnancy Care and Pregnancy Outcomes in Pregestational Diabetes—Are Prior Improvements in Pregnancy Preparation and Outcomes Maintained for Women with Pregestational Diabetes?
Diabetes, 2019Co-Authors: Christine Newman, Aoife M. Egan, Louise Carmody, Lisa A. Owens, Fidelma DunneAbstract:Women with pre-existing diabetes (T1DM/T2DM) face increased risk in pregnancy. Optimising glycaemic control, folic acid use and smoking cessation are all advised to improve outcomes. Maintaining these goals can be difficult. We retrospectively analysed data from sites across our Atlantic DIP network from 2015-17 and compared outcomes to data 2010-14 to see if prior improvements were maintained. Data was collected on pre-pregnancy Care (PPC), glycaemic targets and neonatal outcomes. In total 98 women attended; 76 (78%)/22 (22%) with T1DM and T2DM respectively. Booking maternal BMI reduced but a fall in PPC attendance lead to lower folic acid use, greater teratogenic medication use and static smoking rates. Trimester 1 HbA1C was suboptimal in T1DM but patients subsequently reached target. HbA1C improved throughout pregnancy for T2DM and was at target (Table 1). Between the two time periods outcomes were unchanged for miscarriage, shoulder dystocia, NICU admission, macrosomia, LGA, SGA and birth weight. We recorded no stillbirths or congenital malformations. Improvements occurred in prematurity ( It is reassuring to record maintenance/improvement in neonatal outcomes but ongoing education on the importance of PPC and novel ways to reach patients are required. Disclosure C. Newman: Speaker9s Bureau; Self; Sanofi. L. Carmody: None. A.M. Egan: None. L.A. Owens: None. F. Dunne: None.
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A Prepregnancy Care Program for Women With Diabetes: Effective and Cost Saving.
The Journal of clinical endocrinology and metabolism, 2016Co-Authors: Aoife M. Egan, Andriy Danyliv, Louise Carmody, Breda Kirwan, Fidelma DunneAbstract:Context: Only a minority of women with diabetes attend Prepregnancy Care service and the economic effects of providing this service are unclear. Objective: The objective of the study was to design, put into practice, and evaluate a regional Prepregnancy Care program for women with types 1 and 2 diabetes. Design: This was a prospective cohort and cost-analysis study. Setting: The study was conducted at antenatal centers along the Irish Atlantic Seaboard. Participants: Four hundred fourteen women with type 1 or 2 diabetes participated in the study. Intervention: The intervention for the study was a newly developed Prepregnancy Care program. Main Outcome Measures: 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 nonattendees was evaluated. Results: In total, 149 (36%) attended: this increased from 19% to 50% after increased recruitment measures in 2010. Attendees were more likely...
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Ten years of optimizing outcomes for women with type 1 and type 2 diabetes in pregnancy—the atlantic dip experience
The Journal of clinical endocrinology and metabolism, 2016Co-Authors: L Owens, Aoife M. Egan, Louise Carmody, Fidelma DunneAbstract:Context 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, the program now shares outcomes over its first decade in caring for pregnant women with diabetes. Objective The objective was to assess improvements in clinical outcomes after the introduction of interventions. Design, setting, participants We retrospectively examined 445 pregnancies in women with type 1 and type 2 diabetes and compared them over two timepoints, 2005–2009 and 2010–2014. Inteventions Interventions introduced over that time include: provision of combined antenatal/diabetes clinics, Prepregnancy Care, electronic data management, local clinical Care guidelines, professional and patient education materials, an app, and a web site. Main outcomes Pregnancy outcomes were measured. Results The introduction of the Atlantic Diabetes in Pregnancy program has been associated with a reduction in adverse neonatal outcomes. There has been a reduction in congenital malformations (5 to 1.8%; P = .04), stillbirths (2.3 vs 0.4%; P = .09), despite an upward trend in maternal age (mean age, 31.7 vs 33 years), obesity (29 vs 43%; body mass index >30 kg/m2), and excessive gestational weight gain (24 vs 38%; P = .002). These improvements in outcomes occur alongside an increase in attendance at Prepregnancy Care (23 to 49%; P Conclusions Changing the process of clinical Care delivery and utilizing evidence-based interventions in a pragmatic clinical setting improves pregnancy outcomes for women with pregestational diabetes. We now need to target optimization of maternal body mass index before pregnancy and put a greater focus on gestational weight gain through education and monitoring.
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Diabetic retinopathy in pregnancy: a population-based study of women with pregestational diabetes.
Journal of diabetes research, 2015Co-Authors: Aoife M. Egan, Louise Carmody, Lyle Mcvicker, Adrienne Heerey, Fiona Harney, Fidelma DunneAbstract:The aim of this observational study was to evaluate screening and progression of diabetic retinopathy during pregnancy in women with pregestational diabetes attending five antenatal centres along the Irish Atlantic seaboard. An adequate frequency of screening was defined as at least two retinal evaluations in separate trimesters. Progression was defined as at least one stage of deterioration of diabetic retinopathy and/or development of diabetic macular edema on at least one eye. Women with pregestational diabetes who delivered after 22 gestational weeks () were included. In total, 185 (60.3%) had an adequate number of retinal examinations. Attendance at Prepregnancy Care was associated with receiving adequate screening (odds ratio 6.23; CI 3.39–11.46 ()). Among those who received adequate evaluations (), 48 (25.9%) had retinopathy progression. Increasing booking systolic blood pressure (OR 1.03, CI 1.01–1.06, ) and greater drop in HbA1c between first and third trimesters of pregnancy (OR 2.05, CI 1.09–3.87, ) significantly increased the odds of progression. A significant proportion of women continue to demonstrate retinopathy progression during pregnancy. This study highlights the role of Prepregnancy Care and the importance of close monitoring during pregnancy and identifies those patients at the highest risk for retinopathy progression.