Pre-pregnancy care cuts risks for diabetics

Getting medical care before pregnancy can help women with diabetes control their blood sugar early in pregnancy, and can also reduce the risk of some complications, a new study shows.

Women with type 1 diabetes are more likely to have children with birth defects and babies that die shortly after birth. There is strong evidence that this risk is linked to how tightly blood sugar is controlled early in pregnancy, while the fetus' organs are still forming, Dr. Rosemary C. Temple of Norfolk and Norwich University Hospital in Norwich, UK, and her colleagues write in the journal Diabetes Care.

The only way to ensure that blood sugar is well controlled this early in pregnancy, the team notes, is for women to get care before pregnancy.

To investigate whether attending a clinic for care before pregnancy would in fact improve pregnancy outcomes for diabetic women, the researchers followed 290 pregnant women with type 1 diabetes, 110 of whom received pre-pregnancy care.

Women who got pre-pregnancy care had better blood sugar control for the first half of pregnancy. Just 2.9 percent had adverse pregnancy outcomes such as stillbirth, infant deformities or infant death, compared to 10.2 percent of women who did not get prepregnancy care. Five percent of women who got care before pregnancy had very premature infants, compared to 14.2 percent of women who didn't get care before pregnancy.

However, the researchers found, pre-pregnancy care had no effect on blood sugar control in later pregnancy or the risk of having a very large baby, which is common with diabetic women.

Even so, given the early benefits, they conclude by urging doctors and scientists to find ways to improve diabetic women's use of pre-pregnancy services, and determine whether such services can help women with type 2 diabetes as well.

SOURCE: Diabetes Care, August 2006.