Inadequate pregnancy planning in diabetics, and its impact on glycemic control and complications

Abstract

Introduction: To assess the intention of actual pregnancy and its influence on glycated hemoglobin (HbA1c) profile before and during the pregnancy of women with previous diabetes mellitus (DM).

Methods: Prospective cohort study included pregnant women with previous DM assisted from October/2018 to October/2019. Data were collected with standardized questionnaire and from medical records. Comparisons of variables of interest (Student's t test, Mann-Whitney or chi-square test) were performed between the group of women who did or denied report having interest to become pregnant. And a logistic regression analysis were performed considering prematurity or fetal/neonatal complication as dependent variables.

Results: Sixty patients were included, with HbA1c mean of pre-pregnancy, first and third trimesters of 9.3, 8.1 and 6.8%, respectively. 7.7% women had HbA1c ≤ 6.5% in pre-pregnancy and 16.7% in first trimester. 83.3% reported having received guidance on the importance of glucose control and contraception before their current pregnancy. Although 28.3% reported the intention to become pregnant, only 28.3% reported regular use of any contraceptive method before it, none of which had HbA1c in the recommended goal for pregnancy. Glycemic control did not differ between groups intending or not to become pregnant. Women with adequate glycemic control in first trimester had a lower frequency of prematurity (p = 0.015) and fetal complications (p = 0.001), and better control at the end of pregnancy.

Discussion: Although most of these women reported having had information about the importance of a planned pregnancy, adequate glycemic control of women with diabetes before and during the pregnancy is still not a reality nowadays. It might be necessary to improve medical communication in pregnancy planning.

Keywords: Diabetes mellitus; Family planning; Health literacy; High-risk pregnancy.