Integrated management may improve type 1 diabetes pregnancy outcomes in resource-limited settings
medwireNews: Integrating a comprehensive management plan into the World Health Organization (WHO) maternal care framework has the potential to improve pregnancy outcomes for women with type 1 diabetes, suggest findings from the CARNATION study.
Jianping Weng (University of Science and Technology of China, Hefei) and co-authors explain that the WHO maternal care framework “has been successfully implemented globally, including in China and many low- and middle-income countries,” and the CARNATION management plan was integrated into this pre-existing infrastructure in 11 Chinese centers in 2015–2017.
The plan – comprising an educational leaflet for pregnant women with type 1 diabetes, a checklist for healthcare providers, and educational support for both groups – covered the preconception to postpartum period and included information on diet, managing diabetes and its complications, and blood pressure control.
Among 133 pregnant women with type 1 diabetes attending centers implementing the management plan, 6.02% experienced the composite outcome of severe adverse pregnancy outcomes, defined as maternal or neonatal death, congenital malformations, miscarriage in the second trimester, or stillbirth.
This was lower than the rate of severe pregnancy outcomes in a control cohort of 153 women with type 1 diabetes attending the same centers in 2012–2014 before implementation of the intervention, at 18.30%. After adjustment for potential confounders, the management plan was associated with a significant 69% lower risk for severe adverse pregnancy outcomes.
The researchers also found that the management plan was associated with a significant 78% lower risk for severe adverse pregnancy outcomes when comparing women attending CARNATION centers with a second control cohort of 116 pregnant women with type 1 diabetes receiving routine care at other centers in 2015–2017, at rates of 6.02% versus 25.00%.
Moreover, the management plan was associated with a significant reduction in the risk for second trimester miscarriage and stillbirth, as well as neonatal intensive care unit admission, when either control group was used for comparison.
These findings “are evidence of a potentially clinically important effect of the comprehensive management plan on pregnancy outcomes among Chinese pregnant women with pregestational [type 1 diabetes],” write Weng et al in Diabetes Care.
“The management plan achieved these improvements under a relatively resource-limited setting, suggesting that it was feasible and effective and worth development in [other] countries covered by [the] WHO-recommended maternal care framework,” they add.
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