Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2012

Open Access 01-12-2012 | Research article

Pre-pregnancy care for women with pre-gestational diabetes mellitus: a systematic review and meta-analysis

Authors: Hayfaa A Wahabi, Rasmieh A Alzeidan, Samia A Esmaeil

Published in: BMC Public Health | Issue 1/2012

Login to get access

Abstract

Background

Pre-gestational diabetes mellitus is associated with increased risk for maternal and fetal adverse outcomes. This systematic review was carried out to evaluate the effectiveness and safety of pre-pregnancy care in improving the rate of congenital malformations and perinatal mortality for women with pre-gestational diabetes mellitus.

Methods

We searched the following databases, MEDLINE, EMBASE, WEB OF SCIENCE, Cochrane Library, including the CENTRAL register of controlled trials and CINHAL up to December 2011, without language restriction, for any pre-pregnancy care aiming at health promotion, glycemic control and screening and treatment of diabetes complications in women with type I or type II diabetes mellitus. Study design were trials (randomized and non-randomized), cohort and case–control studies.

Results

Of the 2452 title scanned 54 full papers were retrieved of those 21 studies were included in this review. Twelve cohort studies at low and medium risk of bias, with 3088 women, were included in the meta-analysis. Meta-analysis suggested that pre-pregnancy care is effective in reducing congenital malformation, Risk Ratio (RR) 0.25 (95% CI 0.16-0.37), number needed to treat (NNT) 19 (95% CI 14–24), and perinatal mortality RR 0.34 (95% CI 0.15-0.75), NNT = 46 (95% CI 28–115). Pre-pregnancy care lowers glycosylated hemoglobin A1c (HbA1c) in the first trimester of pregnancy by an average of 1.92% (95% CI −2.05 to −1.79). However women who received pre-pregnancy care were at increased risk of hypoglycemia during the first trimester of pregnancy RR 1.51 (95% CI 1.15-1.99).

Conclusion

Pre-pregnancy care for women with pre-gestational type 1 or type 2 diabetes mellitus is effective in improving rates of congenital malformations, perinatal mortality and in reducing maternal HbA1C in the first trimester of pregnancy. Pre-pregnancy care might cause maternal hypoglycemia in the first trimester of pregnancy.
Appendix
Available only for authorised users
Literature
1.
Ray JG, Vermeulen MJ, Meier C, Wyatt PR: Risk of congenital anomalies detected during antenatal serum screening in women with pregestational diabetes. QJM. 2004, 97: 651-653. 10.1093/qjmed/hch107.CrossRefPubMed
2.
3.
Confidential Enquiry into Maternal and Child Health (CEMACH): Pregnancy in Women with type 1 and type 2 Diabbetes in 2002–2003. England, Wales and Northern Ireland. 2005, London: CEMACH
4.
Reece EA: Maternal fuels, diabetic embryopathy: pathomechanisms and prevention. Semin Reprod Endocrinol. 1999, 17: 183-194. 10.1055/s-2007-1016225.CrossRefPubMed
5.
Mathiesen ER, Ringholm L, Damm P: Stillbirth in diabetic pregnancies. Best Pract Res Clin Obstet Gynaecol. 2011, 25: 105-111. 10.1016/j.bpobgyn.2010.11.001.CrossRefPubMed
6.
Ray JG, O'Brien TE, Chan WS: Pre-pregnancy care and the risk of congenital anomalies in the offspring of women with diabetes mellitus: a meta-analysis. QJM. 2001, 94: 435-444. 10.1093/qjmed/94.8.435.CrossRefPubMed
7.
Temple RC, Aldridge VJ, Murphy HR: Prepregnancy care and pregnancy outcomes in women with type 1 diabetes. Diabetes Care. 2006, 29: 1744-1749. 10.2337/dc05-2265.CrossRefPubMed
8.
Murphy HR, Roland JM, Skinner TC, Simmons D, Gurnell E, Morrish NJ, et al: Effectiveness of a regional prepregnancy care program in women with type 1 and type 2 diabetes: benefits beyond glycemic control. Diabetes Care. 2010, 33: 2514-2520. 10.2337/dc10-1113.CrossRefPubMedPubMedCentral
9.
Wahabi HA, Alzeidan RA, Bawazeer GA, Alansari LA, Esmaeil SA: Pre-conception care for diabetic women for improving maternal and fetal outcomes: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2010, 10: 63-10.1186/1471-2393-10-63.CrossRefPubMedPubMedCentral
10.
11.
DCCT Study Group: Pregnancy outcomes in the Diabetes Control and Complications Trial. Am J Obstet Gynecol. 1996, 174: 1343-1353.CrossRef
12.
Correa A, Botto L, Liu Y, Mulinare J, Erickson JD: Do multivitamin supplements attenuate the risk for diabetes-associated birth defects?. Pediatrics. 2003, 111: 1146-1151.PubMed
13.
Damm P, Molsted-Pedersen L: Significant decrease in congenital malformations in newborn infants of an unselected population of diabetic women. Am J Obstet Gynecol. 1989, 161: 1163-1167.CrossRefPubMed
14.
Dunne FP, Brydon P, Smith T, Essex M, Nicholson H, Dunn J: Pre-conception diabetes care in insulin-dependent diabetes mellitus. QJM. 1999, 92: 175-176. 10.1093/qjmed/92.3.175.CrossRefPubMed
15.
Fuhrmann K, Reiher H, Semmler K, Fischer F, Fischer M, Glockner E: Prevention of congenital malformations in infants of insulin-dependent diabetic mothers. Diabetes Care. 1983, 6: 219-223. 10.2337/diacare.6.3.219.CrossRefPubMed
16.
Fuhrmann K, Reiher H, Semmler K, Glockner E: The effect of intensified conventional insulin therapy before and during pregnancy on the malformation rate in offspring of diabetic mothers. Exp Clin Endocrinol. 1984, 83: 173-177. 10.1055/s-0029-1210327.CrossRefPubMed
17.
Fuhrmann K: Treatment of pregnant insulin-dependent diabetic women. Acta Endocrinol Suppl (Copenh). 1986, 277: 74-76.
18.
Garcia-Patterson A, Corcoy R, Rigla M, Caballero A, Adelantado JM, Altirriba O, et al: Does pre-preconceptional counselling in diabetic women influence perinatal outcome?. Ann Ist Super Sanita. 1997, 33: 333-336.PubMed
19.
Goldman JA, Dicker D, Feldberg D, Yeshaya A, Samuel N, Karp M: Pregnancy outcome in patients with insulin-dependent diabetes mellitus with pre-preconceptional diabetic control: a comparative study. Am J Obstet Gynecol. 1986, 155: 293-297.CrossRefPubMed
20.
Herman WH, Janz NK, Becker MP, Charron-Prochownik D: Diabetes and pregnancy. Pre-conception care, pregnancy outcomes, resource utilization and costs. J Reprod Med. 1999, 44: 33-38.PubMed
21.
Jaffiol C, Baccara MT, Renard E, Apostol DJ, Lefebvre P, Boulot P, et al: [Evaluation of the benefits brought by pregnancy planning in type 1 diabetes mellitus]. Bull Acad Natl Med. 2000, 184: 995-1007.PubMed
22.
Jensen BM, Kuhl C, Molsted-Pedersen L, Saurbrey N, Fog-Pedersen J: pre-preconceptional treatment with insulin infusion pumps in insulin-dependent diabetic women with particular reference to prevention of congenital malformations. Acta Endocrinol Suppl (Copenh). 1986, 277: 81-85.
23.
Kitzmiller JL, Gavin LA, Gin GD, Jovanovic-Peterson L, Main EK, Zigrang WD: pre-conception care of diabetes Glycemic control prevents congenital anomalies. JAMA. 1991, 265: 731-736. 10.1001/jama.1991.03460060063025.CrossRefPubMed
24.
Rosenn B, Miodovnik M, Combs CA, Khoury J, Siddiqi TA: Pre-conception management of insulin-dependent diabetes: improvement of pregnancy outcome. Obstet Gynecol. 1991, 77: 846-849.PubMed
25.
Rowe BR, Rowbotham CJ, Barnett AH: Pre-conception counselling, birth weight, and congenital abnormalities in established and gestational diabetic pregnancy. Diabetes Res. 1987, 6: 33-35.PubMed
26.
Steel JM, Johnstone FD, Hepburn DA, Smith AF: Can prepregnancy care of diabetic women reduce the risk of abnormal babies?. BMJ. 1990, 301: 1070-1074. 10.1136/bmj.301.6760.1070.CrossRefPubMedPubMedCentral
27.
Temple RC, Aldridge V, Stanley K, Murphy HR: Glycaemic control throughout pregnancy and risk of pre-eclampsia in women with type I diabetes. BJOG. 2006, 113: 1329-1332. 10.1111/j.1471-0528.2006.01071.x.CrossRefPubMed
28.
Willhoite MB, Bennert HW, Palomaki GE, Zaremba MM, Herman WH, Williams JR, et al: The impact of preconception counseling on pregnancy outcomes. The experience of the Maine Diabetes in Pregnancy Program. Diabetes Care. 1993, 16: 450-455. 10.2337/diacare.16.2.450.CrossRefPubMed
29.
Steel JM, Johnstone FD, Smith AF, Duncan LJP: Five years' experience of "prepregnancy" clinic for insulin-dependent diabetics. BMJ. 1982, 285: 353-356. 10.1136/bmj.285.6338.353.CrossRefPubMedPubMedCentral
30.
Galindo A, Burguillo AG, Azriel S, Fuente PL: Outcome of fetuses in women with pregestational diabetes mellitus. J Perinat Med. 2006, 34: 323-331.CrossRefPubMed
31.
Boulot P, Chabbert-Buffet N, d’Ercole C, Floriot M, Fontaine P, Fournier A, et al: French multicentric survey of outcome of pregnancy in women with pregestational diabetes. Diabetes Care. 2003, 26: 2990-2993.CrossRefPubMed
32.
Garcia Ingelmo MT, Herranz dM, Martin VP, Janez FM, Grande AC, Pallardo Sanchez LF: [Pre-preconceptional control in diabetic women]. Rev Clin Esp. 1998, 198: 80-84.PubMed
33.
Evers IM, de Valk HW, Visser GH: Risk of complications of pregnancy in women with type 1 diabetes: nationwide prospective study in the Netherlands. BMJ. 2004, 328: 915-10.1136/bmj.38043.583160.EE.CrossRefPubMedPubMedCentral
34.
Corrigan N, Brazil DP, McAuliffe F: Fetal cardiac effects of maternal hyperglycemia during pregnancy. Birth Defects Res A Clin Mol Teratol. 2009, 85: 523-530. 10.1002/bdra.20567.CrossRefPubMed
35.
Persson M, Norman M, Hanson U: Obstetric and perinatal outcomes in type 1 diabetic pregnancies: A large, population-based study. Diabetes Care. 2009, 32: 2005-2009. 10.2337/dc09-0656.CrossRefPubMedPubMedCentral
36.
Persson M, Pasupathy D, Hanson U, Westgren M, Norman M: Pre-pregnancy body mass index and the risk of adverse outcome in type 1 diabetic pregnancies: a population-based cohort study. BMJ Open. 2012, 2: e000601-10.1136/bmjopen-2011-000601.CrossRefPubMedPubMedCentral
37.
Melamed N, Hod M: Perinatal mortality in pregestational diabetes. Int J Gynaecol Obstet. 2009, 104 (Suppl 1): S20-S24.CrossRefPubMed
38.
Jensen DM, Damm P, Moelsted-Pedersen L, Ovesen P, Westergaard JG, Moeller M, et al: Outcomes in type 1 diabetic pregnancies: a nationwide, population-based study. Diabetes Care. 2004, 27: 2819-2823. 10.2337/diacare.27.12.2819.CrossRefPubMed
39.
Platt MJ, Stanisstreet M, Casson IF, Howard CV, Walkinshaw S, Pennycook S, et al: St Vincent's Declaration 10 years on: outcomes of diabetic pregnancies. Diabet Med. 2002, 19: 216-220. 10.1046/j.1464-5491.2002.00665.x.CrossRefPubMed
40.
Riskin-Mashiah S, Younes G, Damti A, Auslender R: First-trimester fasting hyperglycemia and adverse pregnancy outcomes. Diabetes Care. 2009, 32: 1639-1643. 10.2337/dc09-0688.CrossRefPubMedPubMedCentral
41.
Jensen DM, Korsholm L, Ovesen P, Beck-Nielsen H, Moelsted-Pedersen L, Westergaard JG, et al: Peri-conceptional A1C and risk of serious adverse pregnancy outcome in 933 women with type 1 diabetes. Diabetes Care. 2009, 32: 1046-1048. 10.2337/dc08-2061.CrossRefPubMedPubMedCentral
42.
Nielsen GL, Moller M, Sorensen HT: HbA1c in early diabetic pregnancy and pregnancy outcomes: a Danish population-based cohort study of 573 pregnancies in women with type 1 diabetes. Diabetes Care. 2006, 29: 2612-2616. 10.2337/dc06-0914.CrossRefPubMed
43.
Howorka K, Pumprla J, Gabriel M, Feiks A, Schlusche C, Nowotny C, et al: Normalization of pregnancy outcome in pregestational diabetes through functional insulin treatment and modular out-patient education adapted for pregnancy. Diabet Med. 2001, 18: 965-972.CrossRefPubMed
44.
Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, et al: Grading quality of evidence and strength of recommendations. BMJ. 2004, 328: 1490-CrossRefPubMed
45.
46.
Jaouad IC, Elalaoui SC, Sbiti A, Elkerh F, Belmahi L, Sefiani A: Consanguineous marriages in Morocco and the consequence for the incidence of autosomal recessive disorders. J Biosoc Sci. 2009, 41: 575-581. 10.1017/S0021932009003393.CrossRefPubMed
47.
Hussain R, Bittles AH, Sullivan S: Consanguinity and early mortality in the Muslim populations of India and Pakistan. Am J Hum Biol. 2001, 13: 777-787. 10.1002/ajhb.1124.CrossRefPubMed
Metadata
Title
Pre-pregnancy care for women with pre-gestational diabetes mellitus: a systematic review and meta-analysis
Authors
Hayfaa A Wahabi
Rasmieh A Alzeidan
Samia A Esmaeil
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2012
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-12-792

Other articles of this Issue 1/2012

BMC Public Health 1/2012 Go to the issue

Research article

Association of violence against women with religion and culture in Erbil Iraq: a cross-sectional study

Research article

Reliability of the MacArthur scale of subjective social status - Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Study protocol

Rationale, design and methods for a staggered-entry, waitlist controlled clinical trial of the impact of a community-based, family-centred, multidisciplinary program focussed on activity, food and attitude habits (Curtin University’s Activity, Food and Attitudes Program—CAFAP) among overweight adolescents

Research article

Beliefs about optimal age and screening frequency predict breast screening adherence in a prospective study of female relatives from the Ontario Site of the Breast Cancer Family Registry

Research article

Cleavages and co-operation in the UK alcohol industry: A qualitative study

Research article

Transactional relationships and sex with a woman in prostitution: prevalence and patterns in a representative sample of South African men