Introduction: Clinical management of women with type 1 diabetes mellitus is evolving, with the introduction of newer treatment modalities such as continuous subcutaneous insulin (CSII) pumps and continuous glucose monitoring. Recent state and national guidelines take these into account. Relatively small case numbers limit contemporary data on management of women with type 1 diabetes mellitus prior to and during pregnancy, and their clinical outcomes. We aimed to investigate the prepregnancy and antenatal management; compliance with guidelines; and pregnancy outcomes of women with type 1 diabetes mellitus delivering at a single tertiary centre between 2014 and 2018.
Methods: Retrospective case note audit of all women with a prepregnancy diagnosis of type 1 diabetes mellitus delivering at the Women’s and Children’s Hospital, Adelaide, between 2014 and 2018.
Results: We identified 86 women, who had 103 pregnancies, with a prepregnancy diagnosis of type 1 diabetes mellitus between January 2014 and January 2019. Multiparous woman made up 65% of the cohort. Prevalence of macro- or microvascular complications of diabetes was rare. The majority of women (43%) entered pregnancy on a basal-bolus insulin regimen; CSII was less common (22%). Average Hba1c in the first trimester was 7.85%. Hospital admission for maternal complications among this population was common (BSL stabilisation 23%; pre-eclampsia 10%; other maternal 12%); 31% delivered preterm, and 38% at early term gestation. Fetal growth abnormalities were common (LGA 35%, IUGR 5%), as was neonatal admission to NICU/SCN (39%).
Discussion: Despite newer treatment modalities, and clinical practice guidelines, women with type 1 diabetes mellitus in pregnancy continue to represent a population at significant risk of adverse outcome. Significant health resource use is seen among this population, particularly in the form of admission for maternal indications. Late preterm and early term iatrogenic delivery is common, again for maternal indication.