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Meta-Analysis
. 2012 Sep 17:12:792.
doi: 10.1186/1471-2458-12-792.

Pre-pregnancy care for women with pre-gestational diabetes mellitus: a systematic review and meta-analysis

Hayfaa A Wahabi  1 , Rasmieh A Alzeidan, Samia A Esmaeil
Affiliations
Meta-Analysis

Pre-pregnancy care for women with pre-gestational diabetes mellitus: a systematic review and meta-analysis

Hayfaa A Wahabi et al. BMC Public Health. .

Abstract

Background: Pre-gestational diabetes mellitus is associated with increased risk for maternal and fetal adverse outcomes. This systematic review was carried out to evaluate the effectiveness and safety of pre-pregnancy care in improving the rate of congenital malformations and perinatal mortality for women with pre-gestational diabetes mellitus.

Methods: We searched the following databases, MEDLINE, EMBASE, WEB OF SCIENCE, Cochrane Library, including the CENTRAL register of controlled trials and CINHAL up to December 2011, without language restriction, for any pre-pregnancy care aiming at health promotion, glycemic control and screening and treatment of diabetes complications in women with type I or type II diabetes mellitus. Study design were trials (randomized and non-randomized), cohort and case-control studies.

Results: Of the 2452 title scanned 54 full papers were retrieved of those 21 studies were included in this review. Twelve cohort studies at low and medium risk of bias, with 3088 women, were included in the meta-analysis. Meta-analysis suggested that pre-pregnancy care is effective in reducing congenital malformation, Risk Ratio (RR) 0.25 (95% CI 0.16-0.37), number needed to treat (NNT) 19 (95% CI 14-24), and perinatal mortality RR 0.34 (95% CI 0.15-0.75), NNT = 46 (95% CI 28-115). Pre-pregnancy care lowers glycosylated hemoglobin A1c (HbA1c) in the first trimester of pregnancy by an average of 1.92% (95% CI -2.05 to -1.79). However women who received pre-pregnancy care were at increased risk of hypoglycemia during the first trimester of pregnancy RR 1.51 (95% CI 1.15-1.99).

Conclusion: Pre-pregnancy care for women with pre-gestational type 1 or type 2 diabetes mellitus is effective in improving rates of congenital malformations, perinatal mortality and in reducing maternal HbA1C in the first trimester of pregnancy. Pre-pregnancy care might cause maternal hypoglycemia in the first trimester of pregnancy.

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Figures

Figure 1
Figure 1
Process of selection of the studies for the systematic review.
Figure 2
Figure 2
Risk Ratio for congenital malformation from 13 studies of women with pre-gestational diabetes mellitus who did or did not receive pre-pregnancy care. PPC (experimental) = the group who received pre-pregnancy care; NPPC (control) = the group who did not received pre-pregnancy care; CI = Confidence intervals.
Figure 3
Figure 3
Risk ratio for (perinatal mortality) from six studies of women with pre-gestational diabetes mellitus who did or did not receive pre-pregnancy care. PPC (experimental) = the group who received pre-pregnancy care; NPPC (control) = the group who did not received pre-pregnancy care; CI = Confidence intervals.
Figure 4
Figure 4
First trimester mean value of glycosylated hemoglobin A1C from five studies of women with pre-gestational diabetes mellitus who did or did not receive pre-pregnancy care. PPC (experimental) = the group who received pre-pregnancy care; NPPC (control) = the group who did not received pre-pregnancy care; CI = Confidence intervals.
Figure 5
Figure 5
Risk ratio of maternal hypoglycemia from two studies of women with pre-gestational diabetes mellitus who did or did not receive pre-pregnancy care. PPC (experimental) = the group who received pre-pregnancy care; NPPC (control) = the group who did not received pre-pregnancy care; CI = Confidence intervals.
See this image and copyright information in PMC

References

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