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

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

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.

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Funding

Sao Paulo Research Foundation (FAPESP, Fundação de Apoio à Pesquisa do Estado de São Paulo) (Grant number: 2018/21283-4).

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Authors and Affiliations

  1. Graduation Program in Medicine, Universidade Federal de São Paulo, Rua Botucatu, n° 740, Vila Clementino, São Paulo, SP, CEP 04023-062, Brazil

    Roberta Yukari Imai

  2. Department of Medicine, Discipline of Endocrinology, Universidade Federal de São Paulo, Rua Sena Madureira, n° 1500, Vila Clementino, São Paulo, SP, CEP 04021-001, Brazil

    Patrícia Teófilo Monteagudo, Sergio Atala Dib & Patricia Medici Dualib

  3. Department of Medicine, Discipline of Internal Medicine, Universidade Federal de São Paulo, Rua Sena Madureira, n° 1500, Vila Clementino, São Paulo, SP, CEP 04021-001, Brazil

    Patrícia Teófilo Monteagudo

  4. Department of Medicine, Discipline of Obstetrics, Universidade Federal de São Paulo, Rua Napoleão de Barros, n° 875, Vila Clementino, São Paulo, SP, CEP 04024-002, Brazil

    Rosiane Mattar

  5. Post-Graduation Program in Endocrinology and Metabology, Universidade Federal de São Paulo, Rua Estado de Israel, n° 639, Vila Clementino, São Paulo, SP, CEP 04022-001, Brazil

    Sergio Atala Dib & Bianca de Almeida-Pititto

  6. Department of Preventive Medicine, Universidade Federal de São Paulo, Rua Botucatu, n° 740, Vila Clementino, São Paulo, SP, CEP 04023-062, Brazil

    Bianca de Almeida-Pititto

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  1. Roberta Yukari Imai
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  2. Patrícia Teófilo Monteagudo
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  3. Rosiane Mattar
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Contributions

RYI: participated in conception and design, data extraction, organization of the data, interpretation of the results, revised and draft the article. PM: participated in conception and design, interpretation of the results and revised the article. PMD: participated in conception and design, data extraction, interpretation of the results and revised the article. RM: made a critical review and approved the final version to be published. SAD: made a critical review and approved the final version to be published. BAP: participated in conception and design, data extraction, organization of the data, analysis and interpretation of data revised and draft the article.

Corresponding author

Correspondence to Patrícia Teófilo Monteagudo.

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The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Research Ethics Committee of Paulista School of Medicine, São Paulo Hospital, Federal University of Sao Paulo (UNIFESP), under the protocol number CAAE: 00263118.8.0000.5505.

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Imai, R.Y., Monteagudo, P.T., Mattar, R. et al. Inadequate pregnancy planning in diabetics, and its impact on glycemic control and complications. Arch Gynecol Obstet 308, 1229–1238 (2023). https://doi.org/10.1007/s00404-022-06806-8

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  • DOI: https://doi.org/10.1007/s00404-022-06806-8

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