Background: Risk of adverse pregnancy outcomes (APOs) remains high among pregnant women with type 1 diabetes (T1D). We aimed to investigate whether implementation of a comprehensive evidence-based peri-pregnancy management plan was associated with lower rates of APOs among these women.
Methods: This is a nationwide observational cohort study. A comprehensive evidence-based peri-pregnancy management plan for T1D was launched in 11 centers from 8 cities in China. During 2015-2017 we prospectively collected data from all pregnant women with T1D attending these centers. We compared pregnancy outcomes in this prospective cohort (PC) with two comparison populations. These populations were constructed by compiling data from medical records: the first was a retrospective cohort (RC) of pregnant women with T1D attending the same centers during 2012-2014 before the management plan, and the second was a comparison cohort (CC) of pregnant women with T1D receiving routine care during 2015-2017 in the comparison centers. The comparison centers were another 11 centers from 7 cities with matched socio-economic variables and medical facilities. The main outcome was severe APO comprising maternal mortality, neonatal death, congenital malformation(s), miscarriage in the 2nd trimester, and stillbirth.
Results: We included a PC of 133 pregnant women with TID who received the comprehensive management during 2015-2017; a RC of 153 TID pregnancies out of 137544 pregnancies during 2012-2014; and a CC of 116 TID pregnancies out of 165493 pregnancies during 2015-2017. The rate of severe APO was significantly lower in the PC (6.02%) than either the RC (18.30%, adjusted odds ratio[aOR] 0.31, 95% CI 0.13-0.74, P<0.01) or the CC (25.00%, aOR 0.22, 95% CI 0.09-0.52, P<0.001).
Conclusions: Implementation of the comprehensive evidence-based peri-pregnancy management plan is associated with lower risk of APOs among Chinese pregnant women with T1D.
X. Zheng: None. D. Yang: None. S. Luo: None. J. Yan: None. J. Weng: None.
National Health and Family Planning Commission of the People’s Republic of China; Foundation for Public Welfare Industry Research Project (201502011); World Diabetes Foundation (WDF14-921)