Background:
A previous audit revealed high congenital malformation rates in our catchment. A multifaceted awareness campaign with clinical management pathways (Diabetes Contraception and Prepregnancy Planning program: DCAPP) commenced 1st February 2018. We present an initial evaluation of DCAPP.
Methods:
A retrospective analysis of pregnancy data from 1st January 2013 to 31st December 2024. Results were grouped by calendar year of delivery: 2013-2017 (baseline), 2018-2019 (DCAPP-intervention), 2020-2021 (COVID-years), 2022-2024 (post-COVID, passive DCAPP). Changes over time were compared using chi squared (categorical variables) or analysis of variance (continuous variables) corrected for within group variances using Welch.
Results:
462 women (39.6% T1DM; 60.4% T2DM). Mean age in T1DM lower (28±5 years) vs T2DM (33±5 years) (p<0.001). Mean BMI lower in T1DM (28.8±5.9Kg/m2) vs T2DM (34.5±6.6Kg/m2) (p<0.001). Gestational age at first appointment dropped from 16±8weeks (2013-2017) to 13±6weeks (2022-2024), (adjusted p=0.005). HbA1c did not significantly change (7.6±1.5% vs 7.3±1.7%, p=0.453). High dose folate (5.0mg) usage increased from 18.0% to 45.1% (p-value <0.001). There was a non-significant downward trend for major congenital malformations (7.2%-->6.3%-->4.7%-->3.5%, p=0.520). Minor congenital malformations remained unchanged (7.2%-->6.3%-->9.4%-->8.1%, p=0.883). Gestation at delivery (35±5 weeks), macrosomia (birthweight>4kg) (16.8%) and special care nursery admissions (55.8%) were unchanged. Caesarean sections increased from 19.2% to 28.0% (p=0.033). Aspirin use increased from 25.9% to 72.6% (p<0.001) and pre-eclampsia dropped from 26.0% to 8.8% (p<0.001). T1DM vs T2DM did not significantly affect outcomes.
Conclusions:
Non-significant trend towards improved pregnancy preparation after DCAPP.
No significant congenital malformation improvements.
Aspirin use increased significantly with parallel reduction in pre-eclampsia rates.