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Fifteen-year trends and predictors of preparation for pregnancy in women with pre-conception Type 1 and Type 2 diabetes: a population-based cohort study

Lookup NU author(s): Dr Svetlana Glinyanaya, Peter Tennant, Danielle Crowder, Dr Ruth Bell

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Abstract

Aims: To investigate trends in indicators of preparation for pregnancy in women with type 1 and type 2 diabetes and explore their predictors. Methods: Data on 2293 pregnancies delivered during 1996-2010 by women with type 1 (n=1753) and type 2 (n=540) diabetes were obtained from the Northern Diabetes in Pregnancy Survey. Multiple logistic regression was used to analyse the relationship between potential predictors and three indicators of inadequate pregnancy preparation: non-attendance for pre-conception care, no pre-conception folate consumption, and peri-conception HbA1c ≥53mmol/mol (≥7%). Results: Overall, 40.3% of women with diabetes attended preconception care, 37.4% reported pre-conception folate consumption; and 28.2% had adequate peri-conception HbA1c. For all patients, pre-conception folate consumption improved over time, while peri-conception glucose control did not. Attendance for pre-conception care for women with type 1 diabetes significantly declined. Residence in deprived areas, smoking and younger maternal age (for <35 years), were independently associated with all three indicators of inadequate preparation for pregnancy. Additional predictors of inadequate peri-conception HbA1c were: type 1 diabetes [adjusted odds ratio (aOR)=5.51, 95% CI 2.71-11.22], longer diabetes history (aOR=1.16, 1.09-1.23 per year increase for those with <15 years duration), non-white ethnicity (aOR=3.13, 1.23-7.97) and higher BMI (aOR=1.05, 1.01-1.09 per 1kg/m2 increase). Non-attendance for pre-conception care was additionally associated with type 2 diabetes (P=0.003) and multiparity (P<0.0001). Conclusions: There are socio-demographic inequalities in preparation for pregnancy among women with diabetes. Women with type 2 diabetes were less likely to attend pre-conception care. Pre-conception services need to be designed to maximise uptake in all groups.


Publication metadata

Author(s): Glinianaia SV, Tennant PWG, Crowder D, Nayar R, Bell R

Publication type: Article

Publication status: Published

Journal: Diabetic Medicine

Year: 2014

Volume: 31

Issue: 9

Pages: 1104–1113

Print publication date: 01/09/2014

Online publication date: 21/04/2014

Acceptance date: 31/03/2014

ISSN (print): 0742-3071

ISSN (electronic): 1464-5491

Publisher: Wiley-Blackwell Publishing Ltd.

URL: http://dx.doi.org/10.1111/dme.12460

DOI: 10.1111/dme.12460


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