E-Poster Presentation ESA-SRB-ANZBMS 2021

Aim: To assess the glycaemic control and adverse pregnancy outcomes in a multicultural cohort of women with type 1 diabetes.

Method: An audit of the Diabetes in Pregnancy service at Blacktown Hospital was undertaken to identify women with type 1 diabetes between 2010-2020. Data was acquired from the Electronic Medical Record for demographics, trimester specific HbA1c, treatment approach, and adverse pregnancy outcomes. The primary outcome was to evaluate the proportion of women meeting optimal glycaemic control according to ADIPS guidelines (HbA1c ≤ 6.5% in 1st trimester, ≤6.0% in 2nd and 3rd trimesters). Secondary outcomes included the assessment of adverse maternal outcomes (pregnancy loss, pre-eclampsia, pre-term labour) and neonatal outcomes (macrosomia, SGA/IUGR, neonatal hypoglycaemia, respiratory distress), and comparison between women utilising fingerprick or continuous (CGM) glucose monitoring.

Results: Data on 66 pregnancies were analysed. The mean HbA1c in the 1st, 2nd and 3rd trimesters were 7.6%, 6.6% and 6.9% respectively with 26%, 17% and 14% of the cohort achieving respective trimester specific glycaemic targets. A total of 102 adverse pregnancy outcomes occurred (44% maternal, 69% neonatal) in the cohort (Table 1). Pre-term delivery (32%), macrosomia (28%), and neonatal hypoglycaemia (48%) were the most common events. Nineteen women (29% of cohort) utilised CGM. Glycaemic control based on HbA1c was similar between the CGM and non-CGM groups at each trimester time point. Macrosomia occurred less frequently in the CGM (16%, n=3) vs non-CGM group (33%, n=14), with other outcomes similar between groups.

Conclusion: The achievement of tight glycaemic control in pregnancies complicated by type 1 diabetes remains a challenge with glycaemic targets achieved in only a subset of women. Adverse pregnancy outcomes remain occur frequently in this high-risk group of women.