Can preconception care improve birth outcomes for women with diabetes?

This study looked at how pre-conception care (PCC) relates to outcomes for women with diabetes and their infants. It found that women who received PCC had improved blood sugar control during pregnancy and fewer birth defects and pre-term births.

Diabetes during pregnancy increases the risks to both the woman and the infant. Diabetes increases the amount of glucose (sugar) in the blood, which can cause problems in how the organs of the fetus develop. High glucose also causes the fetus to grow larger, which increases preterm birth and birth complications.

These pregnancy difficulties can be reduced by good blood sugar control during and prior to pregnancy. Blood glucose control is measured through the HbA1c levels. Pre-conception care (PCC) is designed to prepare the body for pregnancy.  PCC can include advice on healthy eating, quitting smoking, and switching to medications safe during pregnancy. It is important to review how PCC care can help women with diabetes.

This review included 36 studies that followed 8199 pregnant patients with diabetes. 3213 patients received PCC followed by prenatal care, while 4986 patients received prenatal care alone. PCC included monitoring of blood glucose control. 11 studies also included support for diet and exercise, quitting smoking or alcohol, and/or switching medications.

Women who received PCC had improved blood glucose control during the first trimester (27% lower HbA1c). They also had a 15% lower rate of preterm delivery.

Infants of pregnancies with PCC had a 71% lower risk of birth defects. They had a 54% lower rate of stillbirth or death shortly after birth. There was also a 25% lower risk of requiring intensive care after birth.

This review found that women with diabetes who received PCC had better glucose control during pregnancy and lower rates of preterm delivery.

All pregnancies which received PCC were by definition planned pregnancies, which tend to have better outcomes.

Talk to your doctor regularly about your family planning intentions. Your doctor can help you align your healthcare with your fertility goals.