Effect of Preconceptional Care on Maternal and Fetal Outcomes in Type 1 Diabetes

Introduction: Pregnancy in women with type 1 diabetes (T1D) is associated with increased risk of maternal complications and neonatal morbidity. Our aim is to describe and compare maternal metabolic control and maternal-fetal outcomes (MFO) among pregnant T1D patients optimized preconceptionally (OP) as compared to those with unplanned pregnancies (UP).

Design and methods: We carried out a retrospective study of 92 singleton pregnancies in 79 T1D Caucasian patients, 59 of them were OP and 33 UP who attended our Diabetes and Pregnancy Unit since 2013 to 2017. In each of the groups were evaluated the pre-pregnancy characteristics, in each trimester and the MFO. Preconception A1C goal was <6% without exceeding 6.5% with a glycemic target of a fasting glucose between 70-95mg/dl and 1 hour postprandial 90 -140 mg/dl.

Results: Both groups did not differ by age: 34 (36-43) vs. 31 (21-42) years, T1D duration: 17 (2-35) vs. 14 (1-31) years and pregestational BMI. Pre-pregnancy A1C in OP vs. UP was 5.9% (5.1-6.0) vs. 7.4% (6.8-10.1) p< 0.001. During the first trimester: 5.7% (5.2-6.5) vs. 6.6% (5.7-7.8) p< 0.01, in the 2th: 5.8% (4.8-6.4) vs. 6.3% (5.3-7.0) and in the 3th: 5.9% (5.0-6.5) vs. 6.2% (5.2-6.9) without differences in weight gain and preeclampsia development. OP vs. UP patients had a 27.1% of cesarean delivery vs. 33.3% (p<0.05) with no differences in preterm and instrumental delivery. Regarding fetal outcomes the neonatal birth weight was 3270 gr (2198-4280) vs. 3370 gr (1200-4870) with a higher percentage in the UP of larger for gestational age newborns (15.2% vs. 3.3% p<0.05), malformations (1.6% vs. 15.1% p<0.05) and hypoglycemia (6.7% vs. 27.2% p<0.05). No differences in macrosomía, small for gestational age, shoulder dystocia, jaundice or respiratory distress.

Conclusion: In women with preexisting T1D preconceptional counseling and glycemic optimization represent a fundamental step towards improved pregnancy outcomes. Pre-pregnancy A1C <6% and during the 1th trimester seems to decrease the risk of adverse outcomes.